This protocol addresses skin-limited leukocytoclastic vasculitis (LCV) in which a drug reaction or infection has been identified as the trigger. Most acute episodes of cutaneous LCV are self-limited, and when the cause is obvious — such as a drug or infection — removing or treating that trigger is a crucial initial step and is often sufficient.
This is a next-line protocol for patients who did not achieve resolution of cutaneous vasculitis or resolution of skin and joint symptoms on initial therapy. Agents from the prior line that may have been tried include:
When none of the above agents proves effective or tolerated, the structured protocol moves to immunosuppressive medications — the specific agent selection criteria, monitoring requirements, and decision algorithm are covered in full in the protocol.
If LCV is limited to the skin, the management strategy should mostly focus on symptomatic relief, since the majority of acute episodes of cutaneous SVV are self-limited and do not recur, even without treatment.
When the cause of LCV is obvious, such as infections or drugs, eliminating or treating the trigger whenever possible is crucial and often sufficient.
When LCV occurs in the context of a systemic vasculitis or an underlying disease, or if none of the above-mentioned agents is effective or tolerated, immunosuppressive medications, such as azathioprine (1–2 mg/kg/day, if thiopurine methyltransferase levels are normal), methotrexate (0.2–0.3 mg/kg/week), with folic acid supplementation, and mycophenolate mofetil (2–3 g/day) can be considered, balancing risks and benefits.
DOI: 10.1093/rheumatology/keac115
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