What is Urticarial Vasculitis?
Urticarial vasculitis produces weals that look like ordinary hives but behave differently: each lesion lasts more than 24 hours, burns or stings rather than itching, and often leaves a bruise as it fades. It is inflammation of small blood vessels rather than a simple allergic reaction, and it needs different treatment.
Also called: UV, hypocomplementemic urticarial vasculitis
Who gets Urticarial Vasculitis?
Most often women in their forties and fifties. It may occur alone, or alongside lupus, Sjögren's syndrome, a chronic infection such as hepatitis B or C, a drug reaction, or a blood disorder. The form with low complement levels is more likely to be associated with systemic disease and to involve other organs.
What are the symptoms of Urticarial Vasculitis?
Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:
- Weals lasting longer than 24 hours in the same place — the key distinguishing feature from ordinary urticaria
- Burning or stinging rather than itching
- Bruising, or a brown stain, where lesions have faded
- Joint pain and swelling
- Fever and general malaise
- Abdominal pain
- Breathlessness or wheeze, particularly in the low-complement form and in smokers
- Red or painful eyes
- Swelling of the lips or eyelids
How is Urticarial Vasculitis diagnosed?
The clinical distinction from ordinary urticaria is the starting point: individual lesions outlasting 24 hours, burning rather than itching, and leaving pigmentation.
A skin biopsy from a lesion present for less than 24 hours shows vasculitis and confirms the diagnosis.
Complement levels separate the two forms — normal complement disease is usually skin-limited, low complement disease is more often systemic.
Screening covers ANA, hepatitis B and C, cryoglobulins, serum protein electrophoresis, kidney function and urine testing, and lung function where there is any respiratory symptom.
How is Urticarial Vasculitis treated?
Antihistamines, which control ordinary urticaria, are often ineffective here — their failure is itself a clue to the diagnosis.
Skin-limited disease is treated with colchicine, dapsone or hydroxychloroquine.
More extensive or systemic disease needs corticosteroids with a steroid-sparing agent — mycophenolate, azathioprine or methotrexate — and rituximab or omalizumab in resistant cases.
Any underlying cause identified is treated in its own right. Smoking cessation matters particularly in the low-complement form, given the association with obstructive lung disease.
Living with Urticarial Vasculitis
Skin-limited disease with normal complement often settles within months to a few years. Low-complement disease tends to be chronic and needs ongoing monitoring of kidneys and lungs. Photographing lesions with a time stamp is genuinely useful, since the 24-hour duration is central to the diagnosis and difficult to demonstrate in a clinic appointment.
When should you see a rheumatologist?
Hives that last more than a day in the same place, burn rather than itch, leave a bruise, or come with joint pain and fever should be assessed for urticarial vasculitis rather than treated as ordinary urticaria.
Common questions about Urticarial Vasculitis
How is this different from ordinary hives?
Ordinary hives move around and each spot disappears within hours, itching rather than burning. In urticarial vasculitis each lesion stays put for more than 24 hours, burns or stings, and often leaves a bruise or brown mark.
Why do antihistamines not work?
Because this is inflammation of blood vessels rather than a histamine-driven allergic reaction. Their lack of effect is one of the clues that leads to the correct diagnosis.
Do I need a biopsy?
Usually yes, and timing matters — the biopsy should be taken from a lesion that has been present for less than 24 hours, otherwise the diagnostic features may have gone.
This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.