Maklumat lanjut ― Melayu

Urticarial vasculitis ialah keadaan yang jarang berlaku, ditandai dengan episod gatal‑gatal yang tahan lama atau berulang. Walaupun simptom kulitnya boleh menyerupai sarang kronik, ia unik kerana sarang itu melekat sekurang‑kurangnya 24 jam dan boleh meninggalkan bintik hitam selepas pudar. Punca biasanya tidak diketahui, tetapi kadang‑kadang dapat dicetuskan oleh ubat tertentu, jangkitan, penyakit autoimun, gangguan darah atau kanser. Beberapa kajian pula mengaitkannya dengan selesema COVID‑19 dan H1N1. Keadaan ini juga boleh menjejaskan organ lain seperti otot, buah pinggang, paru‑paru, perut dan mata. Walaupun pemeriksaan tisu khusus dapat mengesahkan diagnosis, ia tidak semestinya diperlukan. Rawatan biasanya dimulakan dengan antibiotik, dapson, colchicine atau hydroxychloroquine untuk kes yang lebih ringan. Untuk kes yang lebih teruk, ubat yang menindas sistem imun seperti methotrexate atau kortikosteroid mungkin diperlukan. Baru‑baru ini, terapi biologi (rituximab, omalizumab, interleukin‑1 inhibitors) telah menunjukkan harapan bagi kes yang sukar.
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.

Seorang lelaki berusia 35 tahun hadir dengan sejarah ruam merah terang dan menyakitkan pada kedua‑dua paha serta kaki selama 15 hari, disertai sakit sendi. Sebelum ruam muncul, dia mengalami jangkitan saluran kencing selama seminggu. Pemeriksaan kulit menunjukkan beberapa plak merah lembut berbentuk cincin, sebahagiannya boleh pudar, pada kedua‑dua belah paha dan kaki. Dia dirawat dengan prednisolone oral (40 mg/hari) selama seminggu bersama antihistamin tidak mengantuk (fexofenadine). Dalam tempoh seminggu, semua ruam hilang sepenuhnya. Tiada ruam berulang selama 6 bulan berikutnya pada pemeriksaan rutin.
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.