Urticarial vasculitis - 蕁麻疹性血管炎
relevance score : -100.0%
ReferencesUrticarial vasculitis 是一種罕見疾病，其特徵是蕁麻疹長期持續或反覆發作。雖然其皮膚症狀可能類似於慢性蕁麻疹，但它們很獨特，因為蕁麻疹會持續至少 24 小時，且退色後可能留下色素沉著（黑斑）。大多數情況原因不明，但有時可能與某些藥物、感染、自體免疫疾病、血液疾病或癌症有關。部分研究甚至將其與 COVID-19 及 H1N1 流感相關聯。此疾病亦可累及身體其他部位，如肌肉、腎臟、肺、胃和眼睛。雖然組織檢查（活檢）可確診，但並非所有病例都必須進行。對於較輕微的患者，治療通常從 antibiotics (抗生素)、dapsone (氨苯砜)、colchicine (秋水仙鹼) 或 hydroxychloroquine (羥氯奎寧) 開始。對於較嚴重的病例，可能需要使用抑制免疫系統的藥物，如 methotrexate (甲氨蝶呤) 或 corticosteroid (皮質類固醇)。近年來，生物療法 (rituximab, omalizumab, interleukin-1 inhibitors) 在難治性病例中展現出希望。
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.
一名 35 歲男性入院，已有 15 天的大腿和小腿出現鮮紅色、疼痛性皮疹以及關節疼痛的病史。出現皮疹前，他曾罹患一週的尿路感染。大腿和小腿兩側皮膚出現幾處柔軟、環形、部分變白的紅色斑塊。醫師給予他為期一週的口服 prednisolone（潑尼松龍）40 毫克/天，並加用 fexofenadine（非索非那定）。一週內，所有皮疹完全消失。於接下來的 6 個月定期檢查中，未再出現皮疹。
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 - 非處方藥
如果您發燒（體溫升高），建議盡快就醫。
應停用可疑藥物（例如抗生素、非類固醇抗發炎藥）。
口服抗組織胺藥，如西替利嗪或氯雷他定，可止癢。
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]
非處方類固醇軟膏效力較低，可能無效。需持續使用一週以上才可能看到改善。
#Hydrocortisone ointment