Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentWhen to See a Provider
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
When to See a Provider
Skin manifestations from vasculitis—what’s known as cutaneous vasculitis—commonly arise on the lower legs as purple, red, or brown bumps. However, other locations and findings, such as open sores, blisters, and patterns of skin discoloration, are also possible.
Alex Liew / Getty Images.
This article will review the unique appearances, potential causes, accompanying symptoms, and treatment of a vasculitis rash.
Vasculitis Rash Symptoms
This photo contains content that some people may find graphic or disturbing.See PhotoDermNet /CC BY-NC-ND
This photo contains content that some people may find graphic or disturbing.See Photo
This photo contains content that some people may find graphic or disturbing.
DermNet /CC BY-NC-ND
The skin is a waterproof protective barrier between a person’s inner body and the environment. It’s divided into three layers, as follows:
The Anatomy of the Skin
A vasculitis rash indicates that blood vessels within the dermis or hypodermis are damaged, causing their walls to swell, weaken, narrow, thicken, bulge, or leak.
Location
Rashes from vasculitis most commonly appear on the lower legs but can occur anywhere, especially in areas prone to trauma or pressure. For example, a vasculitis rash can develop on the feet, thighs, buttocks, arms, trunk, head, and neck.
Onset of Symptoms
There are different types of vasculitis rashes. While they may occur at any age, they are more common in adults than children.
The specific onset of rash symptoms depends on various factors, such as the underlying trigger. For instance, a vasculitis rash that develops as a reaction to a medication often develops seven to 10 days after the drug exposure.
Moreover, vasculitis rashes can arise suddenly or gradually. They can also evolve in appearance over time as the blood vessels become more and more damaged.
Appearance and Shape
A vasculitis rash involving small blood vessels occurs in the top portion of the dermis.
Cutaneous small vessel vasculitis, formerly calledhypersensitivity vasculitis, is the most common vasculitis rash. It usually arises from a reaction to a drug or infection.
With this condition, inflamed small blood vessels in the skin become leaky, and small areas of bleeding develop, causing raised, red, purple, or brown spots (depending on skin tone) to form on the legs, known aspalpable purpura.
Another type of cutaneous small vessel vasculitis isexercise-induced vasculitis, also called golfer’s vasculitis or the Disney rash. This rash develops on one or both legs after prolonged exposure in hot weather, such as below the leg opening of shorts that people would wear playing golf or at theme parks. It appears as red patches, purpura, orweals(itchy, red, or skin-colored welts).
Other possible skin findings in small vessel vasculitis include:
This photo contains content that some people may find graphic or disturbing.See PhotoPurpura.Reproduced with permission from ©DermNet New Zealand and © Raimo Suhonenwww.dermnetnz.org2023.
Reproduced with permission from ©DermNet New Zealand and © Raimo Suhonenwww.dermnetnz.org2023.
Distinguishing Petechiae From Purpura
Medium Vessel
A vasculitis rash involving medium blood vessels occurs deep in the dermis or the subcutaneous layer. Skin findings may include:
Causes and Pictures of Livedo Reticularis
Large Vessel
Skin manifestations are rare with large vessel vasculitis, although they can occur withgiant cell arteritis.
This type of vasculitis primarily affects the branches of theexternal carotid artery, a large artery in the neck. It causes symptoms like headache, scalp tenderness, visual disturbances, and jaw pain when chewing.
If skin findings are present, they may include:
Sensations
Pain, itching, stinging, tingling, numbing, or burning sensations can accompany vasculitis rashes.
Rash, Vascular Disease, and Inflammation
Skin manifestations of vasculitis are related to impaired blood vessel structure and function from inflammation.
The cause of the inflammation in vasculitis varies, potentially stemming from one of the following:
How to Confirm If You Have Vasculitis Rash
If you think you have a vasculitis rash, it’s important to see a healthcare provider and, if possible, adermatologist(a physician specializing in skin diseases).
During the diagnostic process, a dermatologist will:
Medical History and Physical Exam
When evaluating for possible cutaneous vasculitis, a dermatologist will ask about skin symptoms, drug exposures, family medical histories, and past or present health conditions, such as a recent viral infection.
They will also inquire about other non-skin symptoms, which, if present, can suggestsystemic vasculitis(affecting other areas of the body) or an underlying disease.
Systemic vasculitis indicates that blood vessels in organs other than the skin—for example, the liver, kidney, joints, or nerves—are inflamed.
Symptoms of Systemic VasculitisSystemic vasculitis is a more serious, potentially dangerous condition than vasculitis limited to the skin. Symptoms of systemic vasculitis can include:Fever, chills, and night sweatsUnintended weight lossFatigue andmalaise(generalized feeling of being unwell)Joint and muscle achesAbdominal painBlood in the urine or stoolNumbness and weaknessCough or sinus inflammationVision changes
Symptoms of Systemic Vasculitis
Systemic vasculitis is a more serious, potentially dangerous condition than vasculitis limited to the skin. Symptoms of systemic vasculitis can include:Fever, chills, and night sweatsUnintended weight lossFatigue andmalaise(generalized feeling of being unwell)Joint and muscle achesAbdominal painBlood in the urine or stoolNumbness and weaknessCough or sinus inflammationVision changes
Systemic vasculitis is a more serious, potentially dangerous condition than vasculitis limited to the skin. Symptoms of systemic vasculitis can include:
Next, a dermatologist will carefully inspect the affected skin area and perform a complete body examination.
Skin Biopsy
A skin biopsy is necessary to confirm or exclude a diagnosis for any skin finding resembling a vasculitis rash.
Though there are different types of skin biopsy techniques, apunch biopsyis often used when a vasculitis rash is suspected because it can go deep into the skin’s layers.
During a punch biopsy, a dermatologist will perform the following steps:
The obtained skin sample will then be sent to a laboratory, where apathologist(a physician who analyzes tissues) will examine it under a microscope for signs of blood vessel damage.
Other Diagnostic Tests
Initial tests commonly ordered when vasculitis is suspected include:
Rule Out Alternative DiagnosesSeveral conditions may mimic a vasculitis rash. Examples include:Insect bite reactions (e.g.,bedbug bites)Chronic sun exposure (solar purpura)Poor circulation in the legs (stasis dermatitis)Infection of a heart valve’s inner lining (infective endocarditis)Blood-clotting disorders (e.g.,antiphospholipid syndrome)Acute or chronic hives (urticaria)Pyoderma gangrenosum(rare skin disorder causing painful, open wounds on the legs)
Rule Out Alternative Diagnoses
Several conditions may mimic a vasculitis rash. Examples include:Insect bite reactions (e.g.,bedbug bites)Chronic sun exposure (solar purpura)Poor circulation in the legs (stasis dermatitis)Infection of a heart valve’s inner lining (infective endocarditis)Blood-clotting disorders (e.g.,antiphospholipid syndrome)Acute or chronic hives (urticaria)Pyoderma gangrenosum(rare skin disorder causing painful, open wounds on the legs)
Several conditions may mimic a vasculitis rash. Examples include:
How to Treat Acute Vasculitis Rash
Most vasculitis rashes (without systemic involvement) resolve on their own with simple home therapies.
These therapies include:
Though vasculitis rashes tend to go away over a few weeks, in some cases, new skin findings can develop over several weeks to months before resolving completely. Rarely does vasculitis limited to the skin recur or become chronic.
If systemic vasculitis is present, strong medications that suppress the immune system, such as Imuran (azathioprine),CellCept(mycophenolate mofetil), or Rituxan (rituximab), are often considered.
Vasculitis Medications: List of Options for Mild to Severe Symptoms
When to Check In With a Healthcare Provider
See a healthcare provider if you have any skin findings or other symptoms of vasculitis. The spectrum of vasculitis in terms of organ involvement and severity is broad, and some types that involve the skin can progress quickly and be serious.
A prompt and accurate diagnosis is necessary to create the most effective treatment plan.
Summary
Vasculitis is a condition of blood vessel inflammation that may occur in any organ, including the skin. The most common vasculitis rash affects the lower legs and appears as palpable red, purple, or brown spots, depending on skin tone.
Other vasculitis skin findings include lumps, open sores, blisters, and blotchy, lacelike discoloration. Itching, stinging, numbing, or burning sensation can accompany such findings.
There are many possible causes of a vasculitis rash, such as infection or drug exposure. In some cases, the rash is a sign of systemic vasculitis or an underlying disease process like cancer or an autoimmune condition.
A skin biopsy is the hallmark diagnostic test for vasculitis rash. Treatment depends on the severity of the rash, the underlying trigger, and whether or not other organs are involved.
Most vasculitis rashes resolve within a few weeks with simple measures like rest, pain control, and elimination or management of the underlying trigger. For severe or recurrent vasculitis rashes and systemic vasculitis, oral medications that suppress the immune system are considered.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rawlings CR, Fremlin GA, Nash J, Harding K.A rheumatology perspective on cutaneous vasculitis: assessment and investigation for the non-rheumatologist.Int Wound J. 2016;13(1):17-21. doi:10.1111/iwj.12437American Osteopathic College of Dermatology.Structure & Function of Your Skin.Sangolli PM, Lakshmi DV.Vasculitis: a checklist to approach and treatment update for dermatologists.Indian Dermatol Online J. 2019;10(6):617-626. doi:10.4103/idoj.IDOJ_248_18Morgan AJ, Schwartz RA.Cutaneous polyarteritis nodosa: a comprehensive review.Int J Dermatol. 2010;49(7):750-756. doi:10.1111/j.1365-4632.2010.04522.x allowing older article.Mukherjee S, Era N, Mukherjee M, Tripathi SK.Leukocytoclastic vasculitis secondary to clozapine.Indian J Psychiatry. 2019;61(1):94-96. doi:10.4103/psychiatry.IndianJPsychiatry_384_18Goeser MR, Laniosz V, Wetter DA.A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis.Am J Clin Dermatol. 2014;15(4):299-306. doi:10.1007/s40257-014-0076-6Espitia O, Dréno B, Cassagnau E, et al.Exercise-induced vasculitis: a review with illustrated cases.Am J Clin Dermatol. 2016;17(6):635-642. doi:10.1007/s40257-016-0218-0Kimpimäki T, Huotari-Orava R, Antonen J, Vaalasti A.Increased incidence of cutaneous vasculitic ulcers: 30-year results from a population-based retrospective study.Acta Derm Venereol. 2017;97(5):653-654. doi:10.2340/00015555-2608Pincelli MS, Echavarria AMJ, Criado PR, et al.Livedo racemosa: clinical, laboratory, and histopathological findings in 33 patients.Int J Low Extrem Wounds. 2021;20(1):22-28. doi:10.1177/1534734619896938Prieto-Peña D, Castañeda S, Atienza-Mateo B, Blanco R, González-Gay MÁ.A review of the dermatological complications of giant cell arteritis.Clin Cosmet Investig Dermatol. 2021;14:303-312. doi:10.2147/CCID.S284795Chasset F, Francès C.Cutaneous manifestations of medium- and large-vessel vasculitis.Clin Rev Allergy Immunol. 2017;53(3):452-468. doi:10.1007/s12016-017-8612-9Alpsoy E.Cutaneous vasculitis; an algorithmic approach to diagnosis.Front Med (Lausanne). 2022;9:1012554. doi:10.3389/fmed.2022.1012554Okazaki T, Shinagawa S, Mikage H.Vasculitis syndrome-diagnosis and therapy.J Gen Fam Med. 2017;18(2):72-78. doi:10.1002/jgf2.4American Academy of Dermatology Association.Proper wound care: how to minimize a scar.Zarka F, Veillette C, Makhzoum JP.A review of primary vasculitis mimickers based on the Chapel Hill Consensus Classification.Int J Rheumatol. 2020;2020:8392542. doi:10.1155/2020/8392542Fraticelli P, Benfaremo D, Gabrielli A.Diagnosis and management of leukocytoclastic vasculitis.Intern Emerg Med. 2021;16(4):831-841. doi:10.1007/s11739-021-02688-x
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rawlings CR, Fremlin GA, Nash J, Harding K.A rheumatology perspective on cutaneous vasculitis: assessment and investigation for the non-rheumatologist.Int Wound J. 2016;13(1):17-21. doi:10.1111/iwj.12437American Osteopathic College of Dermatology.Structure & Function of Your Skin.Sangolli PM, Lakshmi DV.Vasculitis: a checklist to approach and treatment update for dermatologists.Indian Dermatol Online J. 2019;10(6):617-626. doi:10.4103/idoj.IDOJ_248_18Morgan AJ, Schwartz RA.Cutaneous polyarteritis nodosa: a comprehensive review.Int J Dermatol. 2010;49(7):750-756. doi:10.1111/j.1365-4632.2010.04522.x allowing older article.Mukherjee S, Era N, Mukherjee M, Tripathi SK.Leukocytoclastic vasculitis secondary to clozapine.Indian J Psychiatry. 2019;61(1):94-96. doi:10.4103/psychiatry.IndianJPsychiatry_384_18Goeser MR, Laniosz V, Wetter DA.A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis.Am J Clin Dermatol. 2014;15(4):299-306. doi:10.1007/s40257-014-0076-6Espitia O, Dréno B, Cassagnau E, et al.Exercise-induced vasculitis: a review with illustrated cases.Am J Clin Dermatol. 2016;17(6):635-642. doi:10.1007/s40257-016-0218-0Kimpimäki T, Huotari-Orava R, Antonen J, Vaalasti A.Increased incidence of cutaneous vasculitic ulcers: 30-year results from a population-based retrospective study.Acta Derm Venereol. 2017;97(5):653-654. doi:10.2340/00015555-2608Pincelli MS, Echavarria AMJ, Criado PR, et al.Livedo racemosa: clinical, laboratory, and histopathological findings in 33 patients.Int J Low Extrem Wounds. 2021;20(1):22-28. doi:10.1177/1534734619896938Prieto-Peña D, Castañeda S, Atienza-Mateo B, Blanco R, González-Gay MÁ.A review of the dermatological complications of giant cell arteritis.Clin Cosmet Investig Dermatol. 2021;14:303-312. doi:10.2147/CCID.S284795Chasset F, Francès C.Cutaneous manifestations of medium- and large-vessel vasculitis.Clin Rev Allergy Immunol. 2017;53(3):452-468. doi:10.1007/s12016-017-8612-9Alpsoy E.Cutaneous vasculitis; an algorithmic approach to diagnosis.Front Med (Lausanne). 2022;9:1012554. doi:10.3389/fmed.2022.1012554Okazaki T, Shinagawa S, Mikage H.Vasculitis syndrome-diagnosis and therapy.J Gen Fam Med. 2017;18(2):72-78. doi:10.1002/jgf2.4American Academy of Dermatology Association.Proper wound care: how to minimize a scar.Zarka F, Veillette C, Makhzoum JP.A review of primary vasculitis mimickers based on the Chapel Hill Consensus Classification.Int J Rheumatol. 2020;2020:8392542. doi:10.1155/2020/8392542Fraticelli P, Benfaremo D, Gabrielli A.Diagnosis and management of leukocytoclastic vasculitis.Intern Emerg Med. 2021;16(4):831-841. doi:10.1007/s11739-021-02688-x
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Rawlings CR, Fremlin GA, Nash J, Harding K.A rheumatology perspective on cutaneous vasculitis: assessment and investigation for the non-rheumatologist.Int Wound J. 2016;13(1):17-21. doi:10.1111/iwj.12437American Osteopathic College of Dermatology.Structure & Function of Your Skin.Sangolli PM, Lakshmi DV.Vasculitis: a checklist to approach and treatment update for dermatologists.Indian Dermatol Online J. 2019;10(6):617-626. doi:10.4103/idoj.IDOJ_248_18Morgan AJ, Schwartz RA.Cutaneous polyarteritis nodosa: a comprehensive review.Int J Dermatol. 2010;49(7):750-756. doi:10.1111/j.1365-4632.2010.04522.x allowing older article.Mukherjee S, Era N, Mukherjee M, Tripathi SK.Leukocytoclastic vasculitis secondary to clozapine.Indian J Psychiatry. 2019;61(1):94-96. doi:10.4103/psychiatry.IndianJPsychiatry_384_18Goeser MR, Laniosz V, Wetter DA.A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis.Am J Clin Dermatol. 2014;15(4):299-306. doi:10.1007/s40257-014-0076-6Espitia O, Dréno B, Cassagnau E, et al.Exercise-induced vasculitis: a review with illustrated cases.Am J Clin Dermatol. 2016;17(6):635-642. doi:10.1007/s40257-016-0218-0Kimpimäki T, Huotari-Orava R, Antonen J, Vaalasti A.Increased incidence of cutaneous vasculitic ulcers: 30-year results from a population-based retrospective study.Acta Derm Venereol. 2017;97(5):653-654. doi:10.2340/00015555-2608Pincelli MS, Echavarria AMJ, Criado PR, et al.Livedo racemosa: clinical, laboratory, and histopathological findings in 33 patients.Int J Low Extrem Wounds. 2021;20(1):22-28. doi:10.1177/1534734619896938Prieto-Peña D, Castañeda S, Atienza-Mateo B, Blanco R, González-Gay MÁ.A review of the dermatological complications of giant cell arteritis.Clin Cosmet Investig Dermatol. 2021;14:303-312. doi:10.2147/CCID.S284795Chasset F, Francès C.Cutaneous manifestations of medium- and large-vessel vasculitis.Clin Rev Allergy Immunol. 2017;53(3):452-468. doi:10.1007/s12016-017-8612-9Alpsoy E.Cutaneous vasculitis; an algorithmic approach to diagnosis.Front Med (Lausanne). 2022;9:1012554. doi:10.3389/fmed.2022.1012554Okazaki T, Shinagawa S, Mikage H.Vasculitis syndrome-diagnosis and therapy.J Gen Fam Med. 2017;18(2):72-78. doi:10.1002/jgf2.4American Academy of Dermatology Association.Proper wound care: how to minimize a scar.Zarka F, Veillette C, Makhzoum JP.A review of primary vasculitis mimickers based on the Chapel Hill Consensus Classification.Int J Rheumatol. 2020;2020:8392542. doi:10.1155/2020/8392542Fraticelli P, Benfaremo D, Gabrielli A.Diagnosis and management of leukocytoclastic vasculitis.Intern Emerg Med. 2021;16(4):831-841. doi:10.1007/s11739-021-02688-x
Rawlings CR, Fremlin GA, Nash J, Harding K.A rheumatology perspective on cutaneous vasculitis: assessment and investigation for the non-rheumatologist.Int Wound J. 2016;13(1):17-21. doi:10.1111/iwj.12437
American Osteopathic College of Dermatology.Structure & Function of Your Skin.
Sangolli PM, Lakshmi DV.Vasculitis: a checklist to approach and treatment update for dermatologists.Indian Dermatol Online J. 2019;10(6):617-626. doi:10.4103/idoj.IDOJ_248_18
Morgan AJ, Schwartz RA.Cutaneous polyarteritis nodosa: a comprehensive review.Int J Dermatol. 2010;49(7):750-756. doi:10.1111/j.1365-4632.2010.04522.x allowing older article.
Mukherjee S, Era N, Mukherjee M, Tripathi SK.Leukocytoclastic vasculitis secondary to clozapine.Indian J Psychiatry. 2019;61(1):94-96. doi:10.4103/psychiatry.IndianJPsychiatry_384_18
Goeser MR, Laniosz V, Wetter DA.A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis.Am J Clin Dermatol. 2014;15(4):299-306. doi:10.1007/s40257-014-0076-6
Espitia O, Dréno B, Cassagnau E, et al.Exercise-induced vasculitis: a review with illustrated cases.Am J Clin Dermatol. 2016;17(6):635-642. doi:10.1007/s40257-016-0218-0
Kimpimäki T, Huotari-Orava R, Antonen J, Vaalasti A.Increased incidence of cutaneous vasculitic ulcers: 30-year results from a population-based retrospective study.Acta Derm Venereol. 2017;97(5):653-654. doi:10.2340/00015555-2608
Pincelli MS, Echavarria AMJ, Criado PR, et al.Livedo racemosa: clinical, laboratory, and histopathological findings in 33 patients.Int J Low Extrem Wounds. 2021;20(1):22-28. doi:10.1177/1534734619896938
Prieto-Peña D, Castañeda S, Atienza-Mateo B, Blanco R, González-Gay MÁ.A review of the dermatological complications of giant cell arteritis.Clin Cosmet Investig Dermatol. 2021;14:303-312. doi:10.2147/CCID.S284795
Chasset F, Francès C.Cutaneous manifestations of medium- and large-vessel vasculitis.Clin Rev Allergy Immunol. 2017;53(3):452-468. doi:10.1007/s12016-017-8612-9
Alpsoy E.Cutaneous vasculitis; an algorithmic approach to diagnosis.Front Med (Lausanne). 2022;9:1012554. doi:10.3389/fmed.2022.1012554
Okazaki T, Shinagawa S, Mikage H.Vasculitis syndrome-diagnosis and therapy.J Gen Fam Med. 2017;18(2):72-78. doi:10.1002/jgf2.4
American Academy of Dermatology Association.Proper wound care: how to minimize a scar.
Zarka F, Veillette C, Makhzoum JP.A review of primary vasculitis mimickers based on the Chapel Hill Consensus Classification.Int J Rheumatol. 2020;2020:8392542. doi:10.1155/2020/8392542
Fraticelli P, Benfaremo D, Gabrielli A.Diagnosis and management of leukocytoclastic vasculitis.Intern Emerg Med. 2021;16(4):831-841. doi:10.1007/s11739-021-02688-x
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
