Robert Micheletti, MD gives us his takeaways from his lecture Vasculitis on Saturday November 5, 2022 at the PA/NP Elevate-Derm Conference in Tucson, Arizona.
In this video
In conversation with Veronica Richardson, NP, Dr. Micheletti — director of the Cutaneous Vasculitis Center at the University of Pennsylvania — walks through the most common presentation clinicians will see in derm clinic: palpable purpura on the dependent, lower-leg areas, which points toward an immune-complex-mediated small vessel vasculitis (leukocytoclastic vasculitis, LCV). He contrasts that with medium vessel signs — retiform purpura, subcutaneous nodules, larger ulcerations, digital infarcts, splinter hemorrhages — that mark the "branch point" toward worrying about systemic organ involvement.
On workup, he cautions against reflexively "ordering everything," because you're then forced to interpret results without context. His single most important "test" is a good review of systems; for an initial episode with a negative review, he limits labs to a CBC, basic metabolic panel, and — most importantly — a urinalysis with micro, since glomerulonephritis stays silent until late. He also clarifies how urticarial vasculitis differs from garden-variety hives and when hive-like lesions earn a biopsy.
