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Challenging Clinical Therapeutic Approach to Urticarial Vasculitis: A Case Series
Fabio Artosi1, Terenzio Cosio2, Laura Diluvio3
1Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy.
Journal of Clinical Medicine
|July 12, 2025
Summary
Urticarial vasculitis (UV) treatment is complex, with corticosteroids effective for acute phases and omalizumab showing promise for maintenance. Individualized plans are crucial due to varied patient responses.
Area of Science:
- Dermatology
- Immunology
- Rheumatology
Background:
- Urticarial vasculitis (UV) is a rare small-vessel vasculitis distinct from chronic spontaneous urticaria (CSU).
- UV often presents with systemic manifestations and necessitates systemic therapy.
- A standardized treatment algorithm for UV is currently lacking.
Observation:
- A retrospective study analyzed 11 UV patients (2014-2024) at Tor Vergata University Hospital.
- The cohort was predominantly female (91%) with a mean age of 52.8 years.
- Autoimmune thyroiditis was a common comorbidity (64%); hypocomplementemia was rare (9%).
Findings:
- Antihistamines showed limited efficacy for UV monotherapy.
- Systemic corticosteroids provided rapid acute-phase control.
- Omalizumab yielded variable responses, including complete remission in one patient.
- Other immunosuppressants like methotrexate and cyclosporine had inconsistent outcomes.
Implications:
- UV exhibits diverse clinical presentations and treatment responses.
- Corticosteroids and omalizumab show potential for acute and maintenance therapy, respectively.
- Further research is needed to identify predictive biomarkers and optimize UV treatment strategies.
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