Skin nontumor

Dermal perivascular and vasculopathic reaction patterns

Vasculitis (includes leukocytoclastic)

Last author update: 1 August 2011
Last staff update: 6 September 2022 (update in progress)

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PubMed Search: Vasculitis [title] skin

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Vasculitis (includes leukocytoclastic). website. Accessed February 4th, 2023.
Definition / general
  • Most cases are due to immune complexes
  • May be limited to skin (focal or generalized) or involve internal organs
  • Large vessel vasculitis: associated with Churg-Strauss allergic granulomatosis, polyarteritis nodosa, giant cell arteritis, granulomatosis with polyangiitis (Wegener) and lymphomatoid granulomatosis
  • Leukocytoclastic vasculitis: neutrophilic inflammation with fibrinoid necrosis and fragmented neutrophilic nuclei (leukocytoclasis); it presents as purpuric palpable lesions of lower legs; systemic cases are associated with Henoch-Schonlein pupura (fever, arthralgias, abdominal pain, hematura); also chronic idiopathic urticaria, hypocomplementemia, essential mixed cryoglobulinemia, drug reactions and connective tissue disorders
  • Localized vasculitis, nonnecrotizing, involving vessels larger than capillaries: granuloma faciale, erythema elevatum diutinum and localized, chronic fibrosing vasculitis
  • Lymphocytic, nonnecrotizing vasculitis of small, superficial vessels: bilateral nonblanching purpuric and pigmented macules on ankles and lower legs; due to drug eruption, erythema multiforme, Mucha-Habermann disease, some viral infections, collagen vascular disease, PLEVA and erythema multiforme
  • Fibrin thrombi: present in segmented, hyalinizing vasculitis
  • Infarct of skin: associated with malignant atrophic papulosis (Dego disease); intimal proliferation of deep-seated arteriole
  • Purpura: nonblanching, erythematous macules or papules due to extravasation of red blood cells into dermis
  • Septic vasculitis: also referred to (somewhat erroneously) as nonleukocytoclastic vasculitis, a variant of acute vasculitis associated with various septicemic states, including meningococcal, gonococcal, Pseudomonas and Streptococcal septicemia, infective endocarditis (particularly due to Staphylococcus aureus), secondary syphilis and rickettsial infections
Microscopic (histologic) description
  • Inflammatory infiltrate in wall of dermal or subcutaneous vessels; may be neutrophilic, lymphocytic or granulomatous
  • Often red blood cell extravasation
  • Variable fibrinoid necrosis of vessel walls
  • Variable secondary changes in overlying epidermis and sweat glands
Microscopic (histologic) images

Contributed by Mark R. Wick, M.D.

Breast skin, leukocytoclastic

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Arterial wall is undergoing necrosis

Fragmented remains of neutrophilic nuclei

Lupus related vasculitis

Positive stains
  • Immunoglobulins, complement or fibrin in the vessel wall by direct immunofluorescence
Differential diagnosis
  • Sweet syndrome: neutrophils in dermis, but no distinct vascular involvement
Additional references
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