In
vasculitis, dermatologists generally examine two kinds of patient who present with small-vessel
vasculitis as defined by the Chapel Hill Consensus Conference nomenclature, and idiopathic cutaneous
polyarteritis nodosa (CPN). CPN is a
vasculitis of small and medium-sized arteries within the skin that does not involve internal organs. When these patients visit my clinic, I characterize the cutaneous manifestations at initial presentation and assess the histopathological findings. In systemic antineutrophil cytoplasmic
autoantibody (
ANCA)-associated vasculitis, the characteristic cutaneous clinical pattern of
microscopic polyangiitis is
livedo reticularis, whereas
Churg-Strauss syndrome presents as
purpura and
petechiae with
paresthesias on the lower extremities. When a patient presents with nodules on the elbows with histological palisading
granuloma, diagnosis of three
ANCA-associated vasculitis including
Wegener's granulomatosis should be considered. In
immune-complex-mediated
vasculitis, Henoch-Schönlein
purpura (HSP) is characterized by palpable non-
thrombocytopenic purpura on initial clinical presentation. These clinical cutaneous investigations in
vasculitis patients may allow us to refine our earlier diagnostic strategies. On the other hand, histological examination in a cryoglobulinaemic
vasculitis patient revealed microvascular
thrombus and leucocytoclastic
vasculitis in the dermis. From these findings, I speculated that the presence of
thrombosis may be somehow related to the pathogenesis of the
vasculitis process and investigated the association between
vasculitis, especially
immune-complex-mediated
vasculitis, and
antiphospholipid antibodies (Abs). Serum levels of
IgA anticardiolipin antibody (aCL) are elevated in the initial active stage of adult HSP, suggesting that the
IgA aCL may play some role in the onset of adult HSP. We also suggest that CPN could be dependently associated with the presence of anti-
phosphatidylserine-
prothrombin complex Abs.