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American Journal of Clinical Dermatology

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Open Access 13-11-2024 | Vasculitis | Review Article

Managing Urticarial Vasculitis: A Clinical Decision-Making Algorithm Based on Expert Consensus

Authors: Nikolai Dario Rothermel, Carolina Vera Ayala, Margarida Gonçalo, Jie Shen Fok, Leonie Shirin Herzog, Emek Kocatürk, Sophia Neisinger, Manuel P. Pereira, Indrashis Podder, Polina Pyatilova, Aiste Ramanauskaite, Melba Munoz, Karoline Krause, Marcus Maurer, Hanna Bonnekoh, Pavel Kolkhir

Published in: American Journal of Clinical Dermatology | Issue 1/2025

Abstract

Urticarial vasculitis (UV) is a rare and difficult-to-treat, small-vessel leukocytoclastic vasculitis presenting with recurrent long-lasting wheals. So far, no guidelines and treatment algorithms exist that could help clinicians with the management of UV. In this review, we describe evidence on systemic treatments used for UV and propose a clinical decision-making algorithm for UV management based on the Urticarial Vasculitis Activity Score assessed for 7 days (UVAS7). Patients with occasional UV-like urticarial lesions and patients with UV with skin-limited manifestations and/or mild arthralgia/malaise (total UVAS7 ≤7 of 70) can be initially treated using the step-wise algorithm for chronic urticaria including second-generation H1-antihistamines, omalizumab, and cyclosporine A. Patients with UV with more severe symptoms (UVAS7 >7), especially those with hypocomplementemic UV, may require a multidisciplinary approach, particularly if underlying diseases, for example, systemic lupus erythematosus, cancer, or infection, are present. Immunomodulatory therapy is based on clinical signs and symptoms, and the drug availability and safety profile, and includes systemic corticosteroids, dapsone, hydroxychloroquine, anti-interleukin-1 agents, and other therapies. The level of evidence for all UV treatments is low. Prospective studies with current and novel drugs are needed and could provide further insights into UV pathogenesis and treatment.

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Title: Managing Urticarial Vasculitis: A Clinical Decision-Making Algorithm Based on Expert Consensus
Authors: Nikolai Dario Rothermel
Carolina Vera Ayala
Margarida Gonçalo
Jie Shen Fok
Leonie Shirin Herzog
Emek Kocatürk
Sophia Neisinger
Manuel P. Pereira
Indrashis Podder
Polina Pyatilova
Aiste Ramanauskaite
Melba Munoz
Karoline Krause
Marcus Maurer
Hanna Bonnekoh
Pavel Kolkhir
Publication date: 13-11-2024
Publisher: Springer International Publishing
Keywords: Vasculitis
Vasculitis
Omalizumab
Hydroxychloroquine
Urticaria
Joint Pain
Published in: American Journal of Clinical Dermatology / Issue 1/2025
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI: https://doi.org/10.1007/s40257-024-00902-y

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