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Cutaneous small-vessel vasculitis

Clinical Presentation

A. Skin

- initially, may see red-pink, flat spots (formally called "macules") and raised bumps (formally, "papules")

- Classic appearance is non-blanching, palpable purpura. This looks like deep red to purple spots that feel raised when touched. Purpura refers to the red-purple discolored spots, while palpable means these spots are felt to be slightly raised from the surrounding skin. Additionally, when these bumps are gently pressed, their color does not fade to a lighter color ("non-blanching").

- The red-purple appearance of these spots is due to the inflammation in the blood vessels causing red blood cells to escape and settle in the skin.

- small fluid-filled blisters (or "vesicles), pus-filled bumps resembling a pimple (or "pustules"), or ulcers may also develop, but are less common.

- The location of skin lesions varies but are most commonly found below the waist, primarily on the buttocks and legs. Other distributions include in localized areas above the waist and generalized on several areas of the body.

- With treatment, the lesions typically resolve in weeks to months and leave behind flat spots that are darker than the surrounding skin. (see "Postinflammatory hyperpigmentation" on "Hyperpigmentation")

- Some may experience persistent or recurrent lesions. This tends to occur when the vasculitis is associated with chronic conditions such as connective tissue disease and cryoglobulinemia.

B. Associated symptoms

- The skin lesions are usually asymptomatic but may cause itching, burning, or pain.

- Individuals may experience mild fever, muscle pain, joint pain, or overall feeling of discomfort.

- Additional symptoms depend on the cause of the vasculitis. For example, if the vasculitis a manifestation of Henoch-Schönlein purpura, individuals may also experience abdominal pain or blood in the urine.