Cutaneous vasculitis seen at a skin referral centre in Singapore

To study the clinical features and course of patients presenting to a skin referral centre with cutaneous vasculitis.

A retrospective review of patients presenting to the National Skin Centre from 1993 to 1995 with cutaneous vasculitis was done. All patients included in the study had histologically proven vasculitis on skin biopsy. The clinical manifestations and laboratory investigations of the patients were recorded. The response to the various drugs given as first line therapy and course of the disease 1 year after initial presentation was reviewed.

Forty-seven patients were included in this study. Females outnumbered males in a ratio of approximately 2:1 (32 females versus 15 males). The age of the patients ranged from 14 to 78 years, with a mean of 36 years. The aetiology remained elusive in 70% of cases. Of the known secondary causes, drugs and streptococcal infections were the most frequently implicated. The lower limbs were involved in more than 90% of cases. Cutaneous lesions took the form of palpable purpura, ulcers, nodules and urticaria. Extracutaneous manifestations were present in 47% of patients. The main extracutaneous manifestations were arthralgia/arthritis (21%), microscopic haematuria (16%) and abdominal pain (8%). Direct immunofluorescence on lesional skin was positive in 65% of cases. A raised erythrocyte sedimentation rate was observed in 40% of patients. Positive antinuclear antibodies were detected in 30% of cases. Most patients who were given systemic corticosteroids responded predictably well. The response to other modalities of treatment was more variable. At 1 year follow-up, complete remission was recorded in 47% of the patients, while in 53% of the patients, the disease continued to run a chronic relapsing course.