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Therapeutic Approach

Cutaneous necrotizing vasculitis predominantly involves venules and is known as cutaneous necrotizing vasculitis/venulitis (CNV) and leukocytoclastic vasculitis. CNV maybe restricted to the skin, may occur in association with underlying chronic diseases, may be precipitated by infections or drugs, or may be idiopathic. Idiopathic disorders include IgA vasculitis (IgAV), urticarial vasculitis (UV), and idiopathic vasculitis (IV). Therapeutic approaches will be limited to these idiopathic disorders. Treatment often is unnecessary since the disease may be self-limited with spontaneous resolution, and the focus is on the alleviation of symptoms. Often combinations of therapies rather than a single agent are used, which make it difficult to evaluate the effect of therapeutic agents in the treatment. In the literature, treatment is based on case reports and small case series. None of these agents are FDA-approved. In the author’s experience, treatment usually is initiated with indomethacin and colchicine followed by dapsone and mycophenolate mofetil. The other agents are rarely used and the author almost never uses prednisone. See Table 128-1.

Table 128-1Cutaneous Necrotizing Venulitis Treatment Table

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