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Rheumatology Advance Access originally published online on April 16, 2003
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Rheumatology 2003; 42: 1079-1082
© 2003 British Society for Rheumatology

Surface microscopy for discriminating between common urticaria and urticarial vasculitis

F. Vázquez-López, C. Maldonado-Seral, T. Soler-Sánchez1, N. Perez-Oliva1 and A. A. Marghoob2

Department of Dermatology and
1 Department of Pathology, Central University Hospital, University of Oviedo, Oviedo, Spain and
2 Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, USA

Background. Urticarial vasculitis is a clinicopathological entity that overlaps with common urticaria, and biopsy is required for differentiation between them.

Objective. To determine, for the first time, if skin surface microscopy can aid in the clinical differentiation between common urticaria and urticarial vasculitis in daily practice.

Patients and methods. Lesions in 20 consecutive patients with a clinical diagnosis of urticaria were studied by biopsy and skin surface microscopy (10x dermoscope) after covering the lesions with olive oil. Lesions were photographed with Dermaphot equipment. A biopsy was taken from all patients. Statistical analysis included Fisher's exact test and Cohen {kappa} statistics (intra-observer reproducibility).

Results. Two dermoscopic patterns were observed: (i) a red-lined vascular pattern (17/20 patients); and (ii) a purpuric globular pattern (3/20 patients). Leucocytoclastic vasculitis was demonstrated histologically in all lesions presenting purpuric globules (3/3) but in none of the lesions presenting a dermoscopic red-lined pattern (P < 0.0008). The intra-observer reproducibility for scoring the red lines and purpuric globules was excellent ({kappa}=0.8).

Conclusion. The results of this pilot study suggest that skin surface microscopy, using a 10x dermoscope, detects purpuric globules in urticarial lesions, and that purpuric globules indicate underlying leucocytoclastic vasculitis.

Correspondence to: F. Vázquez López, C/Ezcurdia 192, 3M 33203 Gijón, Spain. E-mail: fvlopez{at}telecable.es


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 Arch DermatolHome page
F. Vazquez-Lopez and A. A. Marghoob
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