BACKGROUND: Urticarial vasculitis is a clinicopathological entity that overlaps with common urticaria, and biopsy is required for differentiation between them. OBJECTIVE: To determine, for the first time, if skin surface microscopy can aid in the clinical differentiation between common urticaria and urticarial vasculitis in daily practice. PATIENTS AND METHODS: Lesions in 20 consecutive patients with a clinical diagnosis of urticaria were studied by biopsy and skin surface microscopy (10x dermoscope) after covering the lesions with olive oil. Lesions were photographed with Dermaphot equipment. A biopsy was taken from all patients. Statistical analysis included Fisher's exact test and Cohen kappa statistics (intra-observer reproducibility). RESULTS: Two dermoscopic patterns were observed: (i). a red-lined vascular pattern (17/20 patients); and (ii). a purpuric globular pattern (3/20 patients). Leucocytoclastic vasculitis was demonstrated histologically in all lesions presenting purpuric globules (3/3) but in none of the lesions presenting a dermoscopic red-lined pattern (P < 0.0008). The intra-observer reproducibility for scoring the red lines and purpuric globules was excellent (kappa=0.8). CONCLUSION: The results of this pilot study suggest that skin surface microscopy, using a 10x dermoscope, detects purpuric globules in urticarial lesions, and that purpuric globules indicate underlying leucocytoclastic vasculitis.
BACKGROUND:Urticarial vasculitis is a clinicopathological entity that overlaps with common urticaria, and biopsy is required for differentiation between them. OBJECTIVE: To determine, for the first time, if skin surface microscopy can aid in the clinical differentiation between common urticaria and urticarial vasculitis in daily practice. PATIENTS AND METHODS: Lesions in 20 consecutive patients with a clinical diagnosis of urticaria were studied by biopsy and skin surface microscopy (10x dermoscope) after covering the lesions with olive oil. Lesions were photographed with Dermaphot equipment. A biopsy was taken from all patients. Statistical analysis included Fisher's exact test and Cohen kappa statistics (intra-observer reproducibility). RESULTS: Two dermoscopic patterns were observed: (i). a red-lined vascular pattern (17/20 patients); and (ii). a purpuric globular pattern (3/20 patients). Leucocytoclastic vasculitis was demonstrated histologically in all lesions presenting purpuric globules (3/3) but in none of the lesions presenting a dermoscopic red-lined pattern (P < 0.0008). The intra-observer reproducibility for scoring the red lines and purpuric globules was excellent (kappa=0.8). CONCLUSION: The results of this pilot study suggest that skin surface microscopy, using a 10x dermoscope, detects purpuric globules in urticarial lesions, and that purpuric globules indicate underlying leucocytoclastic vasculitis.
Authors: Viktoria Puhl; Hanna Bonnekoh; Jörg Scheffel; Tomasz Hawro; Karsten Weller; Peter von den Driesch; Hans-Joachim Röwert-Huber; José Cardoso; Margarida Gonçalo; Marcus Maurer; Karoline Krause Journal: Clin Transl Allergy Date: 2021-04 Impact factor: 5.871