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Comparison of cutaneous manifestations in systemic polyarteritis nodosa and microscopic polyangiitis
N Kluger1, C Pagnoux, L Guillevin
1Service de Dermatologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie, Hôpital Tenon, 4 Rue de la Chine, F-75020 Paris, France.
Background:
The cutaneous manifestations of microscopic polyangiitis (MPA) and polyarteritis nodosa (PAN) have not been compared since their distinction. Objectives To compare the clinical and pathological cutaneous manifestations in a series of patients with systemic MPA and PAN.
Methods:
Patients with MPA (n = 162) and PAN (n = 248) from the database of the French Vasculitis Study Group were diagnosed according to the American College of Rheumatology and/or the Chapel Hill Consensus criteria. Purpura, livedo, nodules, urticaria, skin necrosis, oral and genital ulcers were recorded when present. Fifty-five skin biopsies were analysed. Clinical and histological skin data were compared in the following groups: MPA, PAN and two PAN subsets: PAN with and PAN without hepatitis B infection. The prevalence of systemic and biological manifestations were analysed in relation to the presence or absence of skin lesions. The chi(2) test was used for statistical studies.
Results:
Cutaneous manifestations were present in 44% of MPA and PAN. Purpura was the most frequent manifestation (26% cases of MPA vs. 19% cases of PAN, P = 0.026). Urticaria was more frequent during PAN (6% vs. 1.2%, P = 0.015). Skin lesions were more frequent during PAN in the absence of HBV infection (54% vs. 30%, P < 0.05). No significant difference was detected from the histological data. Patients with skin lesions (either MPA or PAN) presented arthralgias and ocular manifestations more frequently. Mononeuritis multiplex was associated with skin lesions in the MPA group (P < 0.05).
Conclusions:
The clinical or histological analysis of cutaneous lesions is not helpful for distinguishing PAN from MPA.
Insights
Cutaneous manifestations in microscopic polyangiitis (MPA) and polyarteritis nodosa (PAN) show overlap. Clinical and histological skin findings do not reliably distinguish between MPA and PAN, despite differences in purpura and urticaria prevalence.
Area of Science:
- Rheumatology
- Dermatology
- Pathology
Background:
- Microscopic polyangiitis (MPA) and polyarteritis nodosa (PAN) are distinct vasculitides.
- Cutaneous manifestations are common in systemic vasculitides but have not been systematically compared between MPA and PAN since their differentiation.
Purpose of the Study:
- To compare the clinical and pathological features of skin lesions in patients diagnosed with systemic MPA and PAN.
- To determine if cutaneous manifestations can aid in differentiating between MPA and PAN.
Main Methods:
- Retrospective analysis of 162 MPA and 248 PAN patients from the French Vasculitis Study Group database.
- Clinical data on purpura, livedo, nodules, urticaria, skin necrosis, and ulcers were recorded. Fifty-five skin biopsies were analyzed.
- Statistical comparison of clinical and histological data between MPA, PAN, and PAN subsets (with/without hepatitis B infection).
Main Results:
- Cutaneous manifestations were observed in 44% of patients with MPA and PAN.
- Purpura was the most frequent lesion in MPA (26%) compared to PAN (19%). Urticaria was more frequent in PAN (6%).
- Skin lesions were more common in PAN patients without hepatitis B infection. Histological data showed no significant differences. Skin lesions correlated with arthralgias and ocular manifestations.
Conclusions:
- Clinical and histological examination of skin lesions is insufficient to differentiate between microscopic polyangiitis and polyarteritis nodosa.
- While certain lesions like purpura and urticaria show differential prevalence, they are not definitive diagnostic markers.
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