Reappraisal of histopathology of cutaneous polyarteritis nodosa.
BACKGROUND
There is controversy on whether lymphocytic thrombophilic arteritis (LTA) and macular arteritis (MA) are a different entity from cutaneous polyarteritis nodosa (C-PAN).


OBJECTIVE
To evaluate the controversy on LTA/MA by examining the morphologic changes during the dynamic inflammatory process.


METHODS
A clinical and histopathological investigation of 46 biopsy specimens from 21 histopathologically proven C-PAN patients at our hospital was performed.


RESULTS
Most of the biopsy findings revealed arteritis in the subacute and reparative stages. Coexistence of different stages was found in over half of the specimens. Two biopsy specimens consistent with LTA/MA showed coexisting histologically proven (subacute stage) C-PAN in other lesions. Analyses of the longitudinal sections showed focal and segmental arteritis. Patients overall improved well with compression stockings, anti-inflammatory agents, a prostaglandin analog and antiplatelet agents. Currently, three patients are medication free and only require compression stockings.


CONCLUSIONS
LTA/MA seems to be part of the spectrum of C-PAN. The vasculitic lesions of C-PAN are segmental and focal, and coexist in different stages. As the chronic stage of C-PAN can be mistaken as LTA/MA, it is necessary to perform multiple biopsies, serial sections and analyses of longitudinal sections to confirm the main finding of vasculitis.
Department of Dermatology, Saiseikai Central Hospital, Tokyo, Japan.|Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
Ari
A
Morimoto
Department of Dermatology, Saiseikai Central Hospital, Tokyo, Japan.|Meguro Chen Dermatology Clinic, Tokyo, Japan.
Ko-Ron
KR
Chen
D000293:Adolescent; D000328:Adult; D000368:Aged; D001167:Arteritis / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000473:pathology*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000473:pathology*; D055815:Young Adult
compression stockings; cutaneous polyarteritis nodosa; longitudinal section; lymphocytic thrombophilic arteritis; macular arteritis