Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 69, Num. 6, 2003, pp. 427-427

Indian Journal of Dermatology, Venereology, Leprology, Vol. 69, No. 6, Nov-Dec, 2003, pp. 427

Letter To Editor

Urticarial vasculitis of infancy (Acute hemorrhagic edema)

Lakshmi C, Srinivas CR

Dept. of Dermatology, PSG Institute of Medical Sciences & Research, Coimbatore
Correspondence Address:Department of Dermatology, PSG Hospital, Peelamedu, Coimbatore – 641004 psgimsr@md3.vsnl.net.in

Code Number: dv03085

Sir,

We read the article "Urticarial vasculitis in infancy" by Kaur and Thami with interest.[1] We believe that the reported case may be an example of acute hemorrhagic edema and would like to share our experience regarding a similar case.

A 5-year-old girl presented with tender purpuric-ecchymotic plaques ranging from 2.5-4 cm on the right cheek [Figure - 1], lower lip, trunk [Figure - 2], lower limbs and gluteal region. They had a darker hemorrhagic center and showed centrifugal spread, giving a rosette, medallion or target-like configuration described as cockade or medallion-like purpura.[2]

Routine investigations showed leukocytosis and thrombocytosis. The ANA test was negative. Histopathological examination showed leukocytoclastic vasculitis, clinching the diagnosis of acute hemorrhagic edema.[2]

Acute hemorrhagic edema is a benign form of leukocytoclastic vasculitis limited to the skin that occurs in children younger than 2 years of age. It is characterized by circinate, en cockade purpura and ecchymosis of the acral extremities. The clinical manifestations were first described in 1913 by Snow who considered it an infantile variant of Henoch-Schönlein purpura.[3] It was recognized as a distinct clinical entity by Finkelstein (1938) and Seidlmeyer (1939).[2],[3] The remarkable good health of the patient and the benign nature of the disease contrasts with the alarming and extensive skin involvement. The interesting features in our case were the extensive truncal involvement and the occurrence in an older child.

REFERENCES

1.	Kaur S, Thami GP. Urticarial vasculitis in infancy. Indian J Dermatol Venereol Leprol 2003;69:223-4.  Back to cited text no. 1
2.	Baselga E, Drolet BA, Esterly NB. Purpura in infants and children. J Am Acad Dermatol 1997;37:684-5.  Back to cited text no. 2
3.	Taieb A, Le Grain V. Acute hemorrhagic edema of skin in infancy. In: Harper J, Oranje A, Prose N, editors. Textbook of pediatric dermatology. Oxford: Blackwell Science; 2002. p. 1569-73.  Back to cited text no. 3

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