Visible Benefit of Compression for Leukocytoclastic Vasculitis

Introduction

The use of compression stockings has been suggested in the management of leukocytoclastic vasculitis (LCV), however there are a lack of studies in the literature that provide evidence of the benefit of compression therapy in the treatment of LCV.^1,2 Here we present a case that visually demonstrates the efficacy of compression therapy in reducing purpura in a patient with LCV.

Case Presentation

A 65-year-old woman presented with a one-week history of a rash that started on the distal bilateral lower extremities and then spread proximally to involve the thighs and lower back. History was significant for a recent course of amoxicillin for sinusitis. At time of presentation, she was wearing a boot on her right leg due to a recent fracture. Physical exam was significant for annular and retiform non-blanching crops of palpable purpuric papules and petechiae on the bilateral lower extremities, involving left greater than right, with few coalescing into plaques with a central dusky coloration. Histopathologic exam revealed a neutrophilic dermal infiltrate with apoptotic debris and scattered eosinophils, consistent with leukocytoclastic vasculitis that was likely drug related. Direct immunofluorescence did not detect any specific immunodeposits. However, an abnormal urinalysis prompted a kidney biopsy that was consistent with IgA nephropathy, indicating IgA vasculitis. The patient was treated with a prednisone 40 mg taper with improvement in cutaneous symptoms. She continued to wear a boot on the right leg during subsequent follow-up visits and exams were notable for significantly less purpuric lesions on the right leg compared to the left, likely due to the compression that the boot provided (Figure 1).

Figure 1. Note the difference in the appearance of the purpuric lesions on the right leg compared to the left due to the compression from the boot worn on the right leg.

Discussion

Leukocytoclastic vasculitis (LCV) is the most common form of vasculitis of the skin and is characterized by inflammation of small vessels, frequently due to immune complex deposition in the vessel wall.1 The benefits of compression therapy for LCV can be explained by its anti-inflammatory effects. Compression reduces pro-inflammatory cytokines, metalloproteinases, and inflammatory cells, and increases anti-inflammatory cytokines.2 Additionally, it decreases the deposition of immune complexes by preventing dilation of blood vessels.1 Together, these factors all help reduce inflammation at the vessel wall.

We present this case to provide a visual of the effectiveness of compression therapy in the treatment of LCV. Compression therapy should be considered for all patients with LCV as it offers a therapeutic option with minimal significant side effects.1 Further studies should explore the impact of compression therapy on reducing the need for corticosteroids in the management of LCV.2

The authors report no relevant financial disclosures.

1. Sunderkötter C, Bonsmann G, Sindrilaru A, Luger T. Management of leukocytoclastic vasculitis. J Dermatolog Treat. 2005;16(4):193-206. doi:10.1080/09546630500277971

2. Romanelli M, Manzo Margiotta F, Michelucci A, Granieri G, Janowska A, Dini V. Compression therapy in dermatology. Curr Derm Rep. 2023;12(2):33-37. doi:10.1007/s13671-023-00388-7