This protocol addresses skin-limited leukocytoclastic vasculitis in patients where no drug reaction or infection has been identified as a trigger, and where initial conservative management did not achieve resolution of cutaneous vasculitis lesions within the expected 3–4 weeks.
The vasculitis is confined to the skin with no identifiable causative drug or infectious trigger. While most acute episodes of cutaneous small-vessel vasculitis are self-limited and do not require escalated therapy, a subset fails to resolve with conservative measures alone, requiring a structured next step.
The initial approach — rest, avoidance of prolonged standing or walking, leg elevation, compression stockings, and a short course of corticosteroids where indicated — did not result in resolution of cutaneous vasculitis lesions within 3–4 weeks. Failure to reach this endpoint is the indication for escalation to the current protocol.
When skin-limited LCV is severe, intractable, or recurrent, the protocol involves systemic therapy — systemic corticosteroids, with or without adjunctive agents — targeting full resolution of cutaneous and joint symptoms.
DOI: 10.1093/rheumatology/keac115