Hey all. So, interesting enough, as a Rheumatologist I still see a number of people whose primary complaint is a rash and the first question I’m always asked is, “Is it Lupus?” Well, there are a gazillion rashes with a gazillion causes. So, I thought I would touch base on “rash” for a minute. Today, I’m going to address Leukocytoclastic Vasculitis or LCV but will be addressing other autoimmune causes of rashes in future posts coming soon.

Why LCV? Well, I have had two patients over the last month referred to me what might be Leukocyctoclastic Vasculitis or at least a suspicion for this, so I thought, what the heck.

The need to know facts about LCV are pretty straight forward and include:

* Anywhere from 38 to 55 million adults per year end up with this diagnosis

* It is known as a “vasculitis” or, inflammation of small blood vessels

* Can present as hives or as very small and well defined red dots (typically legs)

* Can involve only the skin (superficial only), or, be associated with a systemic issue (i.e. can affect other organs/ tissues)

* Diagnosis is confirmed with biopsy

* Causes:
A new medication – allergic reaction (~10-20%)

A recent infection (~10-20%)

An autoimmune disease (especially RA, Lupus, or Sjogren) (~10-20%)

Cancer (only 1%)

You just have it and it is not associated with anything else (i.e. Idiopathic) (~50%)

* Treatment
Well, it depends on the cause. If secondary to a drug (like an antibiotic), stop drug. If secondary to an
infection, treat the infection. If secondary to an autoimmune rheumatic process, treat that….and so
forth and so on.

Now, if there is no evidence of organ involvement (normal liver, kidney, blood count and urinalysis), then very often a quick course of steroids can help. And, very often, even if you do nothing, it will be resolve without any treatment. So, the most important thing to do is try and see if a cause can be identified. Labs will help.
Typically, a chronic medication is not required unless there is evidence for a secondary cause like Rheumatoid, Lupus, Hepatitis B or C or cancer.

What labs should your doctor order? Here is a basic list:

  • CBC
  • Comprehensive Metabolic Panel
  • Hepatitis B/C and HIV (if risk factors)
  • Cryoglobulins


Now, I want to talk about other autoimmune processes that are known to cause “rash”

* Lupus (rash worse in sun)

* Sjogren’s (autoimmune disease with dry eyes, dry mouth and arthritis)

* Dermatomyositis (inflammatory muscle disease with muscle weakness and rash)

* Psoariasis (plaques that are better in sun)

* Eczema

* Hypothyroidism

* Celiac Disease (Gluten)

* Scleroderma (thick skin that has texture of wood)

* Behcet’s (mouth ulcers, genital ulcers, joint pain)

* Pemphigoid

* Pyoderma Gangrenosum

Anytime someone comes to me and is complaining about a rash, as a Rheumatologist, my first question is always, have you seen a Dermatologist? Have you had a biopsy?

I understand that it can be difficult getting an appointment with a Dermatologist, but, many times, especially if an autoimmune issue is the cause, the biopsy can be extremely valuable. After all, as a Rheumatologist, the question I have to answer is do I suppress your immune system or not? And, this isn’t exactly a great thing if it’s not needed.

So, if you or someone you know has had a rash like this, I advise you or them to seek the opinion of a Rheumatologist or talk with your Primary Care doctor.

I hope this helps and as always, Live Your Value one choice at a time.

More on a couple very common cause of “rash” common soon.

-Dr. D


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