Cutaneous vasculitis associated with acute and chronic hepatitis

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Abstract
Patients (11) who had rashes associated with hepatitis were studied. Five of 6 acute hepatitis cases, but only 1 of 5 chronic hepatitis cases, were related to hepatitis B. Of the 11 patients, 9 had rash in the absence of clinically overt liver disease. Skin biopsy specimens showed histologic evidence of cutaneous vascular injury; specimens of urticarial and maculopapular rashes, which were seen in this series only with acute hepatitis, showed a primarily lymphocytic venulitis with focal necrosis. Palpable purpura, which was seen in this series only in chronic hepatitis, showed a primarily neutrophilic necrotizing vasculitis involving small vessels. A patient had lichen planus-like lesions. Demonstration of vascular deposits of Ig, complement and fibrin in skin, and hypocomplementemia, circulating immune complexes and mixed cryoglobulinemia, in these patients suggests that cutaneous lesions associated with liver disease resulted from immune complex-mediated vascular injury.