“lymphocytic vasculitis” is not urticarial vasculitis
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Haur Yueh Lee, MBBS, MRCP, Shiu Ming Pang,FRCP, FAMS, and Thirumoorthy Thamotharam-pillai, FRCP, FAMS
From the Dermatology Unit, Singapore GeneralHospital, Singapore
Funding sources: None.
Conflicts of interest: None declared.
Reprint requests: Haur Yueh Lee, MBBS, MRCP,Registrar, Dermatology Unit, Singapore GeneralHospital, Outram Rd, Singapore 169608
E-mail: [email protected]
REFERENCES
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doi:10.1016/j.jaad.2008.02.021
Evaluation of rashes in oncology patients
To the Editor: The evaluation of rashes in oncologypatients is often challenging for the dermatologist.These patients are often immunosuppresed, at riskof innumerable infections, on numerous medica-tions (including chemotherapy), and prone to pro-tean paraneoplastic as well as organ-specificdermatoses. In addition, numerous dermatoses inthis population of patients may overlap clinicallyand histologically and/or have atypical clinicalpresentations and/or courses. For example, leuke-mia cutis may mimic a morbilliform rash or perni-osis.1,2 Add to the above the limited amount of timeallotted by the dermatologist for the review of theusually ‘‘thick’’ and often complicated medicalcharts of these patients. At the same time, oncology
J AM ACAD DERMATOL
VOLUME 59, NUMBER 2
Letters 353
‘‘Lymphocytic vasculitis’’ is not urticarialvasculitis
To the Editor: In the June 2007 issue, Lee et al1
reported 22 patients exhibiting the clinical features ofurticarial vasculitis, yet only three of the casesshowed leukocytoclastic vasculitis. The authors con-cluded that the majority of patients with clinicalfeatures of urticarial vasculitis have a lymphocytic-predominant vasculitis with eosinophils.
The cohort of patients in the study by Lee et al hadpersistent urticarial lesions lasting longer than 24hours with two of the following criteria: pain ortenderness; purpura or dusky changes; and resolu-tion with hyperpigmentation. I agree that thesecriteria define a prolonged and possibly severeurticaria, but they do not define urticarial vasculitis.Pain, tenderness, and some purpuric componentwith subsequent postinflammatory hyperpigmenta-tion can be observed in urticaria, especially when thepatient scratches the pruritic lesions. The histopath-ologic correlate of pruritus and scratching is
erythrocyte extravasation and eventual perivascularhemosiderin deposits. Yet this phenomenon doesnot qualify as a true vasculitis and must be inter-preted cautiously and correlated with the clinicalcontext.
Most of the patients in the study did not havehistologic criteria of leukocytoclastic vasculitis, norhypocomplementemia or constitutional symptoms,and therefore probably did not have urticarialvasculitis.
The proper nosology of clinical entities is crucial.Otherwise, the conclusions of the study may bewrongly interpreted as ‘‘lymphocytic vasculitis, acommon finding in urticarial vasculitis.’’
Joan Guitart, MD
Department of Dermatology, Northwestern Univer-sity Feinberg School of Medicine, Chicago,Illinois
Funding sources: None.
Conflicts of interest: None declared.
Correspondence to: Joan Guitart, MD, Departmentof Dermatology, Northwestern University Fein-berg School of Medicine, 676 N St. Clair St, Ste1600, Chicago, IL 60611
E-mail: [email protected]
REFERENCE
1. Lee JS, Loh TH, Seow SC, Tan SH. Prolonged urticaria with
purpura: the spectrum of clinical and histopathologic features
in a prospective series of 22 patients exhibiting the clinical
features of urticarial vasculitis. J Am Acad Dermatol 2007;
56:994-1005.
doi:10.1016/j.jaad.2008.02.028