Urticarial Vasculitis: Attack of the Nettles, Part 1
Feb 28, 2024
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Explore the complexities of urticarial vasculitis, its distinction from other hives like chronic spontaneous urticaria, and the historical evolution of understanding hives. Learn about diagnostic challenges, complement levels, and systemic involvement in urticarial vasculitis, including treatment strategies and immune complex diseases.
Urticarial Vasculitis exhibits distinct skin lesions lasting over 24 hours with systemic manifestations like abdominal pain and joint pain.
Advancements in diagnosing Urticarial Vasculitis include distinguishing hypocomplementemic and normal complementemic subtypes for improved treatment approaches.
Deep dives
Understanding Urticarial Vasculitis
Urticarial Vasculitis is a distinct condition involving skin lesions that can last longer than 24 hours and often leave ecchymotic changes. Unlike typical hives, which are itchy, these lesions have a burning sensation and tend to occur more on the torso rather than the extremities. Notably, this condition is associated with systemic manifestations like abdominal pain, joint pain, and potential glomerular nephritis. Hypocomplementemic Urticarial Vasculitis is linked to more severe systemic involvement, while normal complementemic cases show a less intense presentation.
Historical Context and Diagnostic Advancements
The history of Urticaria dates back centuries, with various types recognized, including contact, solar, cold-induced, and vibration-associated forms. The discovery of histamine in 1907 led to a better understanding of the inflammatory mechanism underlying hives. Diagnostic advancements in Urticarial Vasculitis include distinguishing between hypocomplementemic and normal complementemic subtypes, each with prognostic implications. Skin biopsies revealing necrotizing vasculitis with immune complex deposition have improved the diagnosis and treatment approach.
Treatment Options and Research Insights
Treatment strategies for Urticarial Vasculitis often involve steroids as a first-line option, with varying responses to antihistamines, omalizumab, and rheumatologic medications like Rituximab and IL-1 inhibitors. Studies highlight the importance of immune complex-mediated pathology and the potential role of anti-C1Q antibodies in diagnosis. Research indicates a wide range of prevalence for Urticarial Vasculitis within Urticaria cases, with hypocomplementemic cases showing a higher likelihood of systemic complications.
Is it an allergy or an autoimmune vasculitis, or a little of both? Find out the story of urticarial vasculitis, how this disease was recognized and eventually sorted out from other types of urticaria.
· Intro 0:12
· In this episode 0:21
· Case study 1:22
· Chronic spontaneous urticaria, hives and nettles 7:57