This protocol applies to patients with leukocytoclastic vasculitis confined to the skin and without an identifiable causative drug reaction or infection, in whom first-line management has failed to achieve the expected clinical goals.
The patient has skin-limited leukocytoclastic vasculitis with no identifiable drug or infectious trigger. Because the majority of acute episodes of cutaneous small-vessel vasculitis are self-limited, initial management centres on symptomatic relief — but in this situation those initial measures have proven insufficient.
Treatment with first-line agents — corticosteroids, colchicine, dapsone, hydroxychloroquine, or pentoxifylline — did not achieve the target goals of resolution of cutaneous vasculitis and resolution of skin and joint symptoms. This failure defines the threshold for proceeding to the next treatment step.
When none of the initial agents is effective or tolerated, immunosuppressive therapy is the basis of the next therapeutic step — chosen with careful consideration of individual risk-benefit balance. The full protocol specifies agent selection, monitoring requirements, and the complete treatment algorithm.
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 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.