Urticarial Vasculitis

Urticarial Vasculitis – Wheals and Hives Symptoms on the Skin

Urticarial vasculitis is a skin condition which produces “hives” like symptoms where raised, dark red patchy skin rash (or wheals) appears on the skin but is caused by small vessel vasculitis (small blood vessel inflammation) or leukocytoclastic vasculitis.

The exact mechanism of how urticarial vasculitis is caused in not known and has very similar symptoms to chronic urticaria where there is an outbreak of weals or raised red patchy areas of the skin.

The major difference is that there is vasculitis occurring histologically in the small vessels (under the microscope) where the inflammation is damaging the wall of the vessels or the vascular lumina.

This condition is often linked to systemic symptoms (symptoms that affect the whole body) and is often linked to connective tissue diseases like lupus erthyematosus or other auto-immune connective tissue diseases. People who suffer with Urticarial vasculitis also suffer from renal or internal organ dysfunction.

What can trigger Urticarial Vasculitis?

Rheumatic diseases or systemic diseases such as Sjorgren Syndrome or lupus erthyematosus can trigger this disease.

Certain foods and drinks can trigger vasculitis quickly.

Drugs such as Penicillin, Potassium Iodide, ACE inhibitors and some non-steroidal anti-inflammatory drugs can trigger it also.

Viruses such as Hepatitis B and Hepatitis C can also trigger this condition off. But in general, the exact cause is still largely unknown.

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Signs and Symptoms of Urticarial Vasculitis

  • Wheals appear on the skin and last for more than 24 hours. That is dark red raised skin that is visible
  • They are painful rather than itchy like normal Urticaria (wheals that are mainly triggered by allergic reactions
  • Can feel like they are burning
  • Purpura or the appearance of purple or red discolorations of the skin that do not change colour or is affected when applying pressure. This is caused by bleeding under the skin.
  • Bruising around the skin
  • Pigment change on the skin
  • Fever
  • Generalised pain in the joints and muscles
  • Systemic symptoms like nephritis (inflammation of the kidneys), renal impairment
  • May have increase photosensitivity – that is light can feel intense or painful
  • Shortness of breath may occur
  • Poor response to antihistamine drugs

What is the treatment?


The main treatment is to reduce the pain and inflammation.

This can be done by:

  • Elevation of the limbs using compression stockings
  • A restricted diet if certain foods trigger the condition
  • Cochicine or Dapsone to reduce inflammation in the small blood vessels
  • Anti-histamine medication may be helpful in reducing or treating the symptoms
  • Immunosuppressant drugs
  • In severe cases, high doses of corticosteroids might be used to reduced inflammation and pain