Cutaneous vasculitis - emergency medicine revision
Cutaneous vasculitis is inflammation of dermal blood vessels causing non‑blanching purpura. Presentation ranges from limited, self‑resolving palpable purpura to skin necrosis and life‑threatening systemic vasculitis or invasive infection (for example meningococcal septicaemia, invasive Group A streptococcal disease).
In the ED the priorities are: identify red flags that require immediate treatment as sepsis or urgent specialist care, begin the diagnostic work‑up to detect systemic involvement, and arrange appropriate disposition and follow‑up.
Red flags - immediate action
- Any non‑blanching petechial or purpuric rash with systemic features (fever, hypotension, tachycardia, reduced level of consciousness, meningism) - treat as possible meningococcal septicaemia and activate sepsis pathways (see NICE sepsis guidance and GOV.UK meningococcal guidance).
- Rapidly spreading purpura with bullae, necrosis or skin detachment (purpura fulminans) - requires immediate resuscitation and urgent specialist input.
- Haemodynamic instability, encephalopathy, or signs of significant end‑organ dysfunction (renal impairment, pulmonary haemorrhage, progressive neuropathy) - urgent admission and specialist review required.
- New purpura with laboratory evidence of coagulopathy or DIC (prolonged PT/aPTT, low fibrinogen, raised fibrin‑degradation products) - manage as possible consumptive coagulopathy and escalate urgently.
- Suspected systemic vasculitis with renal involvement (haematuria, proteinuria, rising creatinine), severe pulmonary symptoms or mononeuritis multiplex - requires urgent inpatient assessment and specialist referral (rheumatology/dermatology/immunology).