Cutaneous necrotizing vasculitis: a rational therapeutic approach.

Cutaneous necrotizing vasculitis is a heterogeneous group of disorders characterized clinically by palpable purpura, and histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall, endothelial swelling, and nuclear dust of the post capillary venules. Often, the skin seems the only organ apparently damaged, but systemic involvement may occur. In up to 60% of cases of cutaneous necrotizing vasculitis, the cause remains unknown; in others, it may be due to a variety of underlying conditions such as drugs, chemicals, food allergens, infections, chronic inflammatory systemic disorders, or malignant neoplasms. A rational therapeutic approach of vasculitis begins with the identification and stoppage of any suspected underlying condition. This may be all that is required for the treatment, because it is usually followed by the clearing of cutaneous lesions, and systemic signs and symptoms. In other cases, local and/or systemic anti-inflammatory and/or immunosuppressive therapy is recommended.