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URTICARIAL VASCULITIS DEVELOPED ON THE STRIAE DISTENSAE DURING PREGNANCY
Author(s) -
KWON CHUL WOOK,
LEE CHANG WOO,
KIM YOUNG TAE,
KIM JAE HONG
Publication year - 1993
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/j.1365-4362.1993.tb02753.x
Subject(s) - medicine , erythema , malaise , dermatology , skin biopsy , lesion , abdomen , pregnancy , dermis , physical examination , biopsy , pathology , surgery , biology , genetics
A 23‐year‐old woman (gravida 1, para 0) in her 34th week of pregnancy had urticarial erythema on the legs for a period of 2 weeks. The initial eruptions of erythematous papules, plaques, and urticarial lesions were noted on the calves, at the site of striae distensae. The number of erythematous le‐sions had increased during the last 10 days to cover most of the preexisting sites of striae distensae on the lower legs and thighs, with several satellite lesions (Fig. 1). Individual lesions on the legs were pruritic and persisted longer than 1 day. The lesions of striae distensae on the legs (with urticari‐al erythema) and on the abdomen (without any overlying urticarial lesions) had occurred during pregnancy over the past 8 months. There was no history of drug use, infection, or any other systemic disorders relevant to the skin dis‐ease. Systemic symptoms such as fever, arthralgia, or malaise were not associated with the evolution of the ur‐ticarial erythema. Her past medical history and family history were non‐contributory. She was healthy and maintained uncomplicat‐ed normal pregnancy without any remarkable findings on physical examination except for the skin lesions. A biopsy specimen taken from a satellite lesion showed a moderate degree of perivascular and transmural infiltra‐tion of neutrophils, eosinophils, and lymphohistiocytic cells, with some nuclear dust in the upper dermis. Endothe‐lial swellings and foci of extravasation of red blood cells were also seen (Fig. 2). The direct immunofluorescence study of the same tissue showed deposits of IgM and C3 in the blood vessel walls of the upper dermis (Fig. 2). The erythrocyte sedimentation rate was elevated to 45 mm/h. Complete blood count with differential, platelet count, urinalysis, and stool test for occult blood were within normal limits or negative. The pattern of serum protein electrophoresis, total serum hemolytic complement, and levels of human chorionic gonadotropin were all normal. The results of the tests for antinuciear antibodies, cryoglob‐ulin, hepatitis B surface antigen, and VDRL were negative. The skin lesions of urticarial vasculitis in this patient were treated with oral prednisolone (25 mg/d). The pruritic lesions cleared in a week with no evidence of recurrence until the postpartum period.