Nodular vasculitis – what is it?
DermNet NZ definition: ‘Nodular vasculitis refers to a group of poorly defined conditions causing nodules on the legs, in which inflamed blood vessels (vasculitis) are found on biopsy’.
It mainly occurs in women between ages 30-60 years.
Sometimes it develops in association with tuberculosis. This is called erythema induratum or Bazin disease.
What causes nodular vasculitis?
Nodular vasculitis is a form of panniculitis (inflammation of the fat under the skin). The exact cause is unknown but appears to be associated with slowed circulation. Contributing factors include:
• Cold, fat legs
• High blood pressure
• Diseased or abnormal veins, e.g. inflammation of the veins, varicose veins, venous leg ulcers.
What are the symptoms of nodular vasculitis?
The main symptoms are nodules or lumps on the backs of the lower legs (often concentrated around the ankles), and sometimes the shins. Less commonly the nodules appear on the thighs, arms, trunk and buttocks. The nodules can be of different sizes, ranging from small bumps to large raised areas called plaques. Other symptoms include:
• Aching legs
• Cool skin
• Red-purple discolouration
• Varicose veins
• Leg oedema (leg swelling caused by fluid build-up).
How long do the nodules take to heal?
Most nodules heal slowly without leaving scarring, but can cause a dip or crater in the skin that takes several months to fill. Sometimes the nodules develop into ulcers with a bluish border, and can cause permanent scarring or redness. Ulceration may be triggered by exposure to the cold.
How is nodular vasculitis diagnosed?
Skin biopsy of nodules: reveals inflammation of the fat under the skin, with varying degrees of inflammation of the blood vessels and lymph vessels.
Blood tests: sometimes the erythrocyte sedimentation rate (ESR) is raised, indicating inflammation in the body.
Additional tests for tuberculosis.
How is nodular vasculitis treated?
There is no specific treatment for nodular vasculitis, but the following measures may be helpful.
• Supportive bandages and compression hosiery
• Weight loss
• Raising the legs
• Keeping warm
Treatments for nodular vasculitis are similar to those for erythema nodosum. Helpful medications include:
• Antibiotics – in cases caused by tuberculosis
• Non-steroidal anti-inflammatory drugs, e.g ibuprofen, naproxen.
• Short-term steroids (oral)
• Potassium iodide
• Fibrinolytic therapy (medications that break down blood clots).
• DermNet NZ: Nodular Vasculitis. http://dermnetnz.org/vascular/nodular-vasculitis.html
• Gilchrist, H. and Patterson, J. (2010) Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management. Dermatologic Therapy, Jul-Aug; 23(4): 320-7.
• Medscape: Erythema Induratum (Nodular Vasculitis). http://emedicine.medscape.com/article/1083213-overview