General management approach to common vasculitides

Editor – We recently read the article, ‘An update on the general management approach to common vasculitides’ by Hng, Zhao and Moots.¹

We would like to suggest refinements of the description of dermatological manifestations in a patient with probable vasculitides as outlined their Table 2 and Fig 2, as we are concerned that comments like ‘new persistent rash’ might be a little too generalised and non-specific.

This issue is important to be addressed since there have been significant updates of the classification of vasculitis and dermatologists have strived to define lesions of vasculitis in patients with greater accuracy, and the Chapel Hill Consensus of 2018 reflects those efforts.²

In very simple terms, skin examination findings in vasculitis relate to vessel size. Small vessel vasculitis causes a palpable petechial rash. Medium vessel involvement on the other hand leads to livedo reticularis (a lace like discoloration of skin), ulceration, nodules or macules; while large vessel involvement leads to skin necrosis and ulceration.

We hope our comments are useful and add to the educational aspects of the paper.