Balakrishnan Swapna, Jyothirani E. R, Najeeba Riyas
BACKGROUND Cutaneous small vessel vasculitis is a condition with various aetiologies, morphological patterns of presentation and histopathologic types. It can be primary or secondary. Cutaneous lesions being a pointer to the systemic involvement in vasculitis, it requires histology for confirmation of the diagnosis and for long-term follow up. Skin biopsy is the gold standard in diagnosis and helps in guiding further investigations and treatment. The studies regarding the various patterns and histopathological types of cutaneous small vessel vasculitis in Kerala are not well documented so far. MATERIALS AND METHODS This is a cross-sectional descriptive study done in patients with a histopathological diagnosis of cutaneous small vessel vasculitis admitted in Dermatology Ward of Government Medical College, Kozhikode, during January 2013 to January 2014. The aim of this study was to delineate the patterns, causes and to assess the clinicopathological correlation of cutaneous small vessel vasculitis. A detailed history, clinical examination of patients and 4 mm skin punch biopsy were done in all selected patients. RESULTS 66 patients diagnosed with histopathological features of cutaneous vasculitis were included in the study. Palpable purpura was the most common clinical lesion and leukocytoclastic vasculitis represented the most common histopathologic type of cutaneous small vessel vasculitis in the present study. Systemic involvement was observed in half of the patients. An aetiological association could be found in 62.2% of cases out of which drug sensitivity was the commonest cause. Out of the 66 patients, after clinicopathological correlation, 16 cases of Henoch-Schonlein purpura, 5 cases of urticarial vasculitis, 3 cases of connective tissue disease associated vasculitis (2-systemic lupus erythematosus and 1-mixed connective tissue disorder), 2 cases of Churg-Strauss vasculitis, 2 cases of nodular vasculitis, 2 cases of Behcet’s disease and 3 cases of vasculitic ulcer were identified. Rest of the 33 patients were offered a diagnosis of idiopathic cutaneous small vessel vasculitis. CONCLUSION Definitive diagnosis can be reached with skin biopsy aided with clinical features and relevant investigations including immunofluorescence. Thus, skin biopsy and clinicopathological correlation are important in the diagnosis and treatment of cutaneous small vessel vasculitis.
