Urticarial vasculitis - 蕁麻疹性血管炎
References
Urticarial 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，並且在褪色後可能會導致黑斑。儘管通常原因不明，但有時也可能由某些藥物、感染、自體免疫疾病、血液疾病或癌症引發。一些研究甚至將其與 COVID-19 和 H1N1 流感聯繫起來。它也會影響身體的其他部位，如肌肉、腎臟、肺、胃和眼睛。雖然某種類型的組織檢查可以確診，但這並不總是必要的。對於較輕微的病例，治療通常從抗生素、氨苯砜、秋水仙鹼或羥氯奎寧開始。對於較嚴重的病例，可能需要抑制免疫系統的藥物，如甲胺蝶呤或皮質類固醇。最近，生物療法 (rituximab, omalizumab, interleukin-1 inhibitors) 對疑難病例顯示出了希望。
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。在出現皮疹之前，他患有尿路感染一周。他的大腿和小腿兩側的皮膚出現了幾處柔軟的、環形的、部分變白的紅色斑塊。他接受了為期一週的口服潑尼松龍（40 毫克/天）以及非嗜睡抗組織胺（非索非那定）治療。一週之內，所有皮疹完全消失。在接下來的6個月的定期檢查中，沒有再出現皮疹。
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），我們建議您盡快就醫。
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止癢。
#Cetirizine [Zytec]
#LevoCetirizine [Xyzal]
#Loratadine [Claritin]
非處方類固醇軟膏可能因效力低而無效。需要堅持一周以上才能看到改善。
#Hydrocortisone ointment