Cutaneous Vasculitis: When the Immune System Attacks the Skin’s Blood Vessels

By SWA

 

Cutaneous vasculitis is an inflammatory condition affecting the small blood vessels in the skin, often triggered by an abnormal immune response. It may occur as an isolated skin disease or as part of a broader systemic vasculitis involving internal organs. Recognizing and understanding this condition is crucial, as its manifestations can range from mild skin changes to serious tissue damage.

What Are the Symptoms of Cutaneous Vasculitis?

Because the skin is directly involved, cutaneous vasculitis is often visibly identifiable—if you know what to look for. Common symptoms include:

  • Purpura: Red or purple spots caused by bleeding into the skin, which do not blanch (disappear) when pressed.

  • Petechiae: Very small, pinpoint bleeding spots that typically start on the lower legs.

  • Ulcerations: Painful skin ulcers that develop quickly and can progress rapidly.

  • Necrosis: Tissue death around wounds due to disrupted blood supply.

  • Swelling and redness: Particularly in areas where the vessels are inflamed.

These symptoms may be painful and disfiguring. In more severe cases, deeper tissue damage may occur and heal slowly or leave scars.

What Does Vasculitis Look Like on the Skin?

Cutaneous vasculitis typically presents with small red or purple spots that may merge into larger patches. Unlike many other skin rashes, these spots don’t fade when pressed. This sign—known as non-blanching purpura—is one of the hallmark features of vasculitis.

Causes: Primary and Secondary Cutaneous Vasculitis

Cutaneous vasculitis may be primary (with no underlying condition) or secondary to other causes. Common triggers include:

  • Infections, such as worm infestations (e.g., helminths)

  • Medications, including:

    • Aspirin (ASA)

    • Allopurinol

    • Thiazide diuretics

    • Sulfonamides

    • NSAIDs (non-steroidal anti-inflammatory drugs)

    • Penicillins and tetracyclines

    • Antidepressants

    • Propylthiouracil (used for thyroid disorders)

Identifying a triggering factor—especially medications—is essential for effective treatment.

Is Cutaneous Vasculitis Dangerous?

While it may seem confined to the skin, cutaneous vasculitis can be serious. Inflammation of the blood vessels can lead to lasting damage if left untreated. Possible complications include:

  • Organ damage, if systemic involvement is present

  • Chronic wounds or ulcerations

  • Secondary infections due to open skin lesions

Prompt diagnosis and treatment are key to avoiding long-term consequences.

Diagnosis: How Is Cutaneous Vasculitis Identified?

Diagnosis usually begins with a clinical examination by a specialist, such as a vascular medicine expert (angiologist or phlebologist). Further steps include:

  • Blood tests, including:

    • Inflammatory markers (CRP, ESR)

    • ANCA (anti-neutrophil cytoplasmic antibodies), often elevated in vasculitis

  • Skin biopsy, which can confirm vasculitis by showing inflammation of the vessel walls

  • Imaging studies, if systemic involvement is suspected

Treatment of Cutaneous Vasculitis

Treatment depends on the underlying cause and the severity of symptoms:

  • Eliminating the trigger, such as stopping a causative medication

  • Immunosuppressive therapy, primarily corticosteroids like prednisolone

  • Other immunosuppressants may be used for more severe or resistant cases (e.g., methotrexate or azathioprine)

  • Wound care for ulcers or necrotic areas

  • Pain management

Most cases resolve with proper treatment, but close medical follow-up is essential, especially if there's concern for systemic vasculitis.

Differential Diagnoses: What Else Could It Be?

Several other diseases may mimic the symptoms of cutaneous vasculitis, including:

  • Rheumatic diseases, such as systemic lupus erythematosus (with its butterfly-shaped facial rash)

  • Psoriatic arthritis, which presents with scaly, thickened red patches

  • Dermatomyositis, an autoimmune disease that affects both skin and muscles

  • Clotting disorders, particularly if skin bruising or bleeding happens easily and without trauma

Conclusion

Cutaneous vasculitis is an immune-mediated inflammation of small skin blood vessels, often presenting with painful, non-blanching red spots, ulcers, and necrosis. Although its symptoms appear on the skin, the underlying disease can sometimes affect internal organs and should not be underestimated. Timely diagnosis, identification of triggers, and appropriate treatment—often involving corticosteroids—are essential for successful management.

Disclaimer: This article is for informational purposes only and is not a substitute for medical advice. If you suspect you have vasculitis, please consult a healthcare provider promptly.

 

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742

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