Urticarial vasculitis - 蕁麻疹性血管炎
References
Urticarial vasculitis は、じんましんの長期持続または再発を特徴とするまれな症状です。皮膚症状は慢性蕁麻疹に似ていることもありますが、蕁麻疹は少なくとも 24 時間持続し、色褪せた後に黒い斑点を引き起こす可能性があるという点で独特です。原因は不明であることが多いですが、特定の薬剤、感染症、自己免疫疾患、血液疾患、がんによって引き起こされる場合もあります。いくつかの研究では、それを新型コロナウイルス感染症 (COVID-19) や新型インフルエンザと関連付けていることさえあります。また、筋肉、腎臓、肺、胃、目などの体の他の部分にも影響を与える可能性があります。特定の種類の組織検査で診断を確定できますが、必ずしも必要というわけではありません。治療は通常、軽症の場合は抗生物質、ダプソン、コルヒチン、またはヒドロキシクロロキンから始まります。より重篤な場合には、メトトレキサートやコルチコステロイドなどの免疫系を抑制する薬が必要になる場合があります。最近、生物学的療法 (rituximab, omalizumab, interleukin-1 inhibitors) が困難な症例に対して有望であることが示されています。
Urticarial vasculitis is a rare clinicopathologic entity that is characterized by chronic or recurrent episodes of urticarial lesions. Skin findings of this disease can be difficult to distinguish visually from those of chronic idiopathic urticaria but are unique in that individual lesions persist for ≥24 hours and can leave behind dusky hyperpigmentation. This disease is most often idiopathic but has been linked to certain drugs, infections, autoimmune connective disease, myelodysplastic disorders, and malignancies. More recently, some authors have reported associations between urticarial vasculitis and COVID-19, as well as influenza A/H1N1 infection. Urticarial vasculitis can extend systemically as well, most often affecting the musculoskeletal, renal, pulmonary, gastrointestinal, and ocular systems. Features of leukocytoclastic vasculitis seen on histopathologic examination are diagnostic of this disease, but not always seen. In practice, antibiotics, dapsone, colchicine, and hydroxychloroquine are popular first-line therapies, especially for mild cutaneous disease. In more severe cases, immunosuppressives, including methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine, as well as corticosteroids, may be necessary for control. More recently, select biologic therapies, including rituximab, omalizumab, and interleukin-1 inhibitors have shown promise for the treatment of recalcitrant or refractory cases.
Urticarial vasculitis is a rare clinicopathologic entity that is characterized by chronic or recurrent episodes of urticarial lesions. Skin findings of this disease can be difficult to distinguish visually from those of chronic idiopathic urticaria but are unique in that individual lesions persist for ≥24 hours and can leave behind dusky hyperpigmentation. This disease is most often idiopathic but has been linked to certain drugs, infections, autoimmune connective disease, myelodysplastic disorders, and malignancies. More recently, some authors have reported associations between urticarial vasculitis and COVID-19, as well as influenza A/H1N1 infection. Urticarial vasculitis can extend systemically as well, most often affecting the musculoskeletal, renal, pulmonary, gastrointestinal, and ocular systems. Features of leukocytoclastic vasculitis seen on histopathologic examination are diagnostic of this disease, but not always seen. In practice, antibiotics, dapsone, colchicine, and hydroxychloroquine are popular first-line therapies, especially for mild cutaneous disease. In more severe cases, immunosuppressives, including methotrexate, mycophenolate mofetil, azathioprine, and cyclosporine, as well as corticosteroids, may be necessary for control. More recently, select biologic therapies, including rituximab, omalizumab, and interleukin-1 inhibitors have shown promise for the treatment of recalcitrant or refractory cases.
35歳の男性が、15日前から両大腿部と脚に真っ赤な痛みを伴う発疹と関節痛を訴えて来院しました。発疹が現れる前に、彼は 1 週間尿路感染症を患っていました。彼の皮膚には、大腿部と脚の両側に、柔らかく、リング状で、部分的に白化する赤い斑点がいくつか見られました。彼には、眠気を催さない抗ヒスタミン薬（フェキソフェナジン）とともに、経口プレドニゾロン（40mg/日）が1週間投与されました。 1週間以内にすべての発疹が完全に消えました。その後6か月の定期検査では発疹はなくなりました。
A 35-year-old man came in with a 15-day history of bright red, painful rashes on both thighs and legs, along with joint pain. He had a urinary tract infection for a week before the rash appeared. His skin showed several tender, ring-shaped, partially blanchable, red plaques on both sides of his thighs and legs. He was given oral prednisolone (40mg/day) for a week along with a non-drowsy antihistamine (fexofenadine). Within a week, all the rashes disappeared completely. There were no more rashes during the next 6 months of regular check-ups.
A 35-year-old man came in with a 15-day history of bright red, painful rashes on both thighs and legs, along with joint pain. He had a urinary tract infection for a week before the rash appeared. His skin showed several tender, ring-shaped, partially blanchable, red plaques on both sides of his thighs and legs. He was given oral prednisolone (40mg/day) for a week along with a non-drowsy antihistamine (fexofenadine). Within a week, all the rashes disappeared completely. There were no more rashes during the next 6 months of regular check-ups.
○ 治療 ― OTC医薬品
発熱（体温上昇）がある場合には、早めに受診されることをお勧めします。
疑わしい薬剤は中止する必要があります。 （例：抗生物質、非ステロイド性抗炎症薬）
かゆみにはセチリジンやロラタジンなどの経口抗ヒスタミン薬。
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]
市販のステロイド軟膏は効果が弱いため効果が無い場合があります。改善を確認するには1週間以上塗布する必要があります。
#Hydrocortisone ointment