SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (36)

Leukocytoclastic vasculitis in Child
Other Resources UpToDate PubMed

Leukocytoclastic vasculitis in Child

Contributors: Andrew Walls MD, Nasro Isaq, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Leukocytoclastic vasculitis (LCV) is a small vessel vasculitis that predominantly affects postcapillary venules in the dermis.

LCV can occur in all ages and in both sexes. It is more commonly found in adults, but up to 10% of cases are in the pediatric population. The clinical hallmark of LCV is palpable purpura: purpuric papules and plaques erupt symmetrically on the shins 7-10 days after an inciting factor. Other parts of the lower extremities may be involved, including thighs and dorsal feet. Less frequently, the buttocks, upper extremities, and abdomen are involved. Initially, purpuric macules may be seen that give way to palpable purpura. In more advanced cases, bullae and ulcers may be seen. While the majority of cases are asymptomatic, LCV can be associated with pruritus, pain, or burning.

A variety of inciting factors have been identified, including medications (especially antibiotics, NSAIDs, and diuretics), pathogens (hepatitis viruses, human immunodeficiency virus [HIV], Epstein-Barr virus, and streptococci), malignancy, inflammatory bowel disease, or connective tissue disease (systemic lupus erythematosus [SLE], Sjögren syndrome, and rheumatoid arthritis). Exercise-induced vasculitis, also known as golfer's vasculitis, is a very rare cause of LCV. It is triggered by strenuous exercise, such as running, prolonged walking, or golfing, particularly during warm weather. Up to 50% of cases, however, have no identifiable cause and are considered idiopathic.

Pathogenically, antigen-antibody complexes bind to the endothelium. The complement cascade is subsequently activated, effecting neutrophil chemotaxis. Vessel wall damage then ensues secondary to proteolytic enzymes and reactive oxygen species released by neutrophils.

The physician will need to differentiate skin-limited LCV from LCV with systemic involvement that may include fever, myalgias, malaise, lymphadenopathy, abdominal pain, melena, hematochezia, diarrhea, hematuria, lower extremity swelling, or paresthesias.


L95.8 – Other vasculitis limited to the skin

60555002 – Hypersensitivity angiitis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

The differential diagnosis for LCV is extensive. A skin biopsy will largely aid in the diagnosis.

Other small vessel vasculitis:
  • Immunoglobulin A vasculitis (formerly Henoch-Schönlein purpura) – Acute onset of palpable purpura usually seen in children aged younger than 10 years in the lower extremities / buttocks 1-2 weeks after a respiratory infection. Fever, arthralgias, and renal and gastrointestinal involvement are commonly seen. Can occur in adults. Renal sequelae are of significant concern in these patients.
  • Urticarial vasculitis (UV) – Recurrent, painful eruptions of urticarial lesions that last for more than 24 hours (assists in differentiating from typical urticaria) with or without angioedema. Fever, malaise, myalgias, and arthritis are commonly associated. UV has a strong association with autoimmune disease, such as SLE and Sjögren syndrome, and these entities should be investigated. Complement levels can predict systemic involvement; normal levels are seen with cutaneous limited disease, hypocomplementemic levels are seen with arthritis and gastrointestinal and pulmonary involvement.
  • Microscopic polyangiitis – High incidence of renal involvement with associated weight loss, fever, and other systemic symptoms. Typically ANCA positive (about 10% are ANCA negative).
  • Erythema elevatum diutinum – Violaceous, erythematous, or brown papules, nodules, and/or plaques, predominantly over the extensor surfaces of the body. Chronic course with spontaneous resolution after 5-10 years.
Other small vessel vasculitis that also affects medium-sized vessels (typically with systemic organ involvement):

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required

Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

Subscription Required


Subscription Required

Last Reviewed:11/16/2016
Last Updated:11/10/2022
Copyright © 2023 VisualDx®. All rights reserved.
Leukocytoclastic vasculitis in Child
A medical illustration showing key findings of Leukocytoclastic vasculitis : Palpable purpura, Arthralgia, Urticarial plaque
Clinical image of Leukocytoclastic vasculitis - imageId=893185. Click to open in gallery.
Copyright © 2023 VisualDx®. All rights reserved.