Mer informasjon ― Norsk

Urticarial vasculitis er en sjelden tilstand preget av langvarige eller tilbakevendende episoder med elveblest. Mens hudsymptomene kan ligne kronisk elveblest, er de unike fordi utslettene varer i minst 24 timer og kan etter falming etterlate mørke flekker. Selv om årsaken ofte er ukjent, kan tilstanden noen ganger utløses av bestemte medisiner, infeksjoner, autoimmune sykdommer, blodsykdommer eller kreft. Noen studier har også knyttet den til COVID‑19 og H1N1‑influenza. Systemisk kan den påvirke muskler, nyrer, lunger, mage og øyne. En vevsundersøkelse kan bekrefte diagnosen, men er ikke alltid nødvendig. Behandlingen starter vanligvis med dapsone, colchicine eller hydroxychloroquine for milde tilfeller. Ved mer alvorlige tilfeller kan immundempende legemidler som methotrexate eller corticosteroids være nødvendig. De siste årene har biologiske terapier (rituximab, omalizumab, interleukin‑1 inhibitors) vist lovende resultater i vanskelige tilfeller.
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.

En 35‑år gammel mann kom inn med en 15‑dagers historie med knallrøde, smertefulle utslett på både lår og ben, samt leddsmerter. Han hadde hatt en urinveisinfeksjon i en uke før utslettet dukket opp. Huden hans viste flere ømme, ringformede, delvis blancherbare, røde plakk på begge sider av lårene og bena. Han fikk oral prednisolon (40 mg/dag) i én uke sammen med et ikke‑døsig antihistamin (fexofenadin). Innen en uke var alle utslettene helt borte. Det oppsto ingen nye utslett i løpet av de neste seks månedene med regelmessige kontroller.
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.