Skin-nontumor / Clinical dermatology
Other dermatoses

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 20 April 2017, last major update August 2011

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Vasculitis [title] skin

Cite this page: Vasculitis. website. Accessed April 23rd, 2017.
Definition / General
  • Most cases are due to immune complexes
  • May be limited to skin (focal or generalized) or involve internal organs
  • Large vessel vasculitis: associated with Churg-Strauss allergic granulomatosis, polyarteritis nodosa, giant cell arteritis, Wegener’s granulomatosis and lymphomatoid granulomatosis
  • Leukocytoclastic vasculitis: neutrophilic inflammation with fibrinoid necrosis and fragmented neutrophilic nuclei (leukocytoclasis); it presents as purpuric palpable lesions of lower legs; systemic cases are associated with Henoch-Schonlein pupura (fever, arthralgias, abdominal pain, hematura); also chronic idiopathic urticaria, hypocomplementemia, essential mixed cryoglobulinemia, drug reactions and connective tissue disorders
  • Localized vasculitis, non-necrotizing, involving vessels larger than capillaries: granuloma faciale, erythema elevatum diutinum and localized, chronic fibrosing vasculitis
  • Lymphocytic, non-necrotizing vasculitis of small, superficial vessels: bilateral nonblanching purpuric and pigmented macules on ankles and lower legs; due to drug eruption, erythema multiforme, Mucha-Habermann disease, some viral infections, collagen vascular disease, PLEVA and erythema multiforme
  • Fibrin thrombi: present in segmented, hyalinizing vasculitis
  • Infarct of skin: associated with malignant atrophic papulosis (Dego's disease); intimal proliferation of deep-seated arteriole
  • Purpura: non-blanching, erythematous macules or papules due to extravasation of red blood cells into dermis
  • Septic vasculitis: also referred to (somewhat erroneously) as non-leukocytoclastic vasculitis, a variant of acute vasculitis associated with various septicemic states, including meningococcal, gonococcal, Pseudomonas and Streptococcal septicemia, infective endocarditis (particularly due to Staphylococcus aureus), secondary syphilis and rickettsial infections
Micro Description
  • Inflammatory infiltrate in wall of dermal or subcutaneous vessels; may be neutrophilic, lymphocytic or granulomatous
  • Often red blood cell extravasation
  • Variable fibrinoid necrosis of vessel walls
  • Variable secondary changes in overlying epidermis and sweat glands
Micro Images

Images hosted on PathOut servers:

Breast skin, leukocytoclastic, courtesy of Mark R. Wick, M.D.

Images hosted on other servers:

Small vessel vasculitis (drug induced)

Arterial wall is undergoing necrosis

Fragmented remains of neutrophilic nuclei

Lupus related vasculitis

Positive Stains
  • Immunoglobulins, complement or fibrin in the vessel wall by direct immunofluorescence
Differential Diagnosis
Additional References