An approach to vasculitis and vasculopathy.

My approach to vasculitis and vasculopathy includes: (1) Determine the level of care the patient needs. If I am not sure, I will order a basic laboratory evaluation while I decide on the more specific laboratory tests to order and of course do a skin biopsy. (2) Determine if the eruption represents vasculitis or vasculopathy. The presence of livedo reticularis or retiform purpura points toward vasculopathy, but keep in mind the overlap, especially with the ANCA-associated vasculitides. (3) If vasculitis, rule out the secondary causes (ie, infection, drug reactions, malignancy, connective-tissue disorders) first. (4) Determine the size of the vessel involvement and the organ systems involved, which will narrow down the differential diagnosis. Although no one approach works for everyone, I find this method to be simple and keeps you organized when tackling the workup of vasculitis and vasculopathy.