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Q. Can you help with my urticarial vasculitis?

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 18, 2016 and last reviewed on: Nov 25, 2019

Hi doctor,

For the past one year, I have been having bouts of urticarial vasculitis with lumps under skin on upper arms which turn to large rusty red areas before bruising yellow and fading away. The rash is transient and moves around the body across thighs, etc. My knees go red and there is a blue swelling. I am having low grade fever and malaise. Now the fingers next to thumbs on both hands are turning in with pronounced bony lumps on the fingers on the joints nearest the nails. Neck gets stiff and elbows have red areas too. I have feeling in the chest though seems to be asthma related apparently. My ESR and CRP are normal, but I have eosinophilia. My liver and kidney functions are fine, but alkaline phosphatase is borderline high. I have confirmed vitamin D deficiency and osteopenia. I have raised anticardiolipins since mid twenties and it never become normal. Can you help? My paternal grandmother had Paget's disease and rheumatoid arthritis. Low C3 and C4 have been identified in my son and also with my nephew. Currently, I am taking Venlafaxine for symptoms of menopause.

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Hi,

Welcome to icliniq.com.

Well, urticaria can be very disabling. I am not sure if they done the biopsy of the lesion yet, but to label it as vasculitis we need a biopsy. The reason is difference in management between urticarial vasculitis and urticaria.

Also, could you give me more details on the treatment taken previously for urticarial vasculitis? It needs a long course with steroids along with other immunosuppresion.

If urticaria, we need to manage it with antiallergics in high dose. Do let me know these queries as the diagnosis is still in doubt here.

Revert back with the answers to a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Hi doctor,

I have only had antihistamines. I have attached the picture of the lesion for your reference. Thanks.

#

Hi,

Welcome back to icliniq.com.

I have seen the pictures (attachment removed to protect patient identity).

It is quite a big uritcarial rash. I would like to know whether it has ever been biopsied.

If it is vasculitis, anti allergics will only help partially.

Secondly, tell me the dosage and medications of antiallergics you are taking. As one needs to be on a higher dose of antiallergics for urticaria than the routine ones.

Revert back with the details to a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist



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