Cutaneous Vasculitis: A Pragmatic Study on the Dermatological Conundrum

Background: Cutaneous small vessel vasculitis (CSVV) represents the most common form of vasculitis seen in dermatology practice. It presents with a wide spectrum of clinical and histological patterns that poses a diagnostic challenge. Aim: To study cutaneous vasculitis with respect to its spectrum of cutaneous and systemic manifestations, histopathology, and requisite laboratory investigations, which will enable to identify the etiology. Materials and Methods: We conducted a descriptive study on 34 clinically diagnosed cases of cutaneous vasculitis at a tertiary care hospital in India for 12 months. Histopathological examination was performed in all patients whereas sixteen patients underwent direct immunofluorescence testing. Complete hemogram, erythrocyte sedimentation rate, urine analysis, liver and renal function tests, and antinuclear antibody (ANA) testing were done. Further, ANA profile, anti- neutrophil cytoplasmic antibodies (ANCA) test, rheumatoid factor, chest X-ray, and antistreptolysin O titers were performed in selected cases. They were classified using the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Results: Out of 34 patients, 5 had vasculitis associated with systemic disease, and 2 patients each had drug-, infection-, and malignancy-associated CSVV. A specific etiology was, thus, identified in 11 (32.34%) cases. Histopathological examination showed leucocytoclastic vasculitis in 30 (88.2%) cases. This included 23 patients with CSVV, 6 patients with Immunoglobulin A vascultitis and one patient with vaculitis associated with systemic disease. Conclusion: CSVV can have a multifactorial etiology. Although complete clinical and laboratory workup is required to arrive at the diagnosis, a pragmatic approach with selection of investigations based on clinical acumen is equally effective.