Archives of Dermatological Research

, Volume 301, Issue 1, pp 117–121 | Cite as

Cutaneous polyarteritis nodosa: revisiting its definition and diagnostic criteria

  • Tomoyuki Nakamura
  • Nobuo Kanazawa
  • Takaharu Ikeda
  • Yuki Yamamoto
  • Kimimasa Nakabayashi
  • Shoichi Ozaki
  • Fukumi Furukawa
Review

Abstract

Polyarteritis nodosa (PN) is a classical collagen disease with poor prognosis that demonstrates systemic necrotizing vasculitis of small and medium-sized arteries. Cutaneous symptoms are observed in 25–60% of PN patients. On other hand, cutaneous polyarteritis nodosa (CPN) is designated for the cutaneous limited form of PN and demonstrates benign prognosis. However, there has been much debate on whether or not CPN can progress to PN. Although CPN lesions are fundamentally limited to skin, some CPN cases show extracutaneous symptoms such as peripheral neuropathy and myalgia. According to PN diagnostic criteria, which were established by the Ministry of Health, Labour and Welfare of Japan, a disease with both cutaneous and at least one extracutaneous symptom with appropriate histopathological findings can be diagnosed as PN. The same is true according to diagnostic criteria established by the American College of Rheumatology. In addition, there are no specific diagnostic criteria for CPN. In this study, CPN cases were retrospectively collected from multiple Japanese clinics, and analyzed for detailed clinical and histopathological manifestations, in order to redefine the clinical entity of CPN and to propose appropriate diagnostic criteria for CPN and PN. According to the CPN description in Rook’s Textbook of Dermatology, we collected 22 cases with appropriate histopathological findings. Of the 22 cases, none progressed to PN or death during the follow-up period, 32% had peripheral neuropathy and 27% had myalgia. Regarding extracutaneous symptoms with CPN, 17 dermatological specialists in vasculitis sustained the opinion that CPN can be accompanied by peripheral neuropathy and myalgia but these symptoms are limited to the same area as skin lesions. Based on these results, we devised new drafts for CPN and PN diagnostic criteria. Our study shows the efficacy of these criteria and most dermatologists recognized that our new diagnostic criteria for CPN and PN are appropriate at the present time. In conclusion, this study suggests that CPN does not progress to PN, and introduces new drafts for CPN and PN diagnostic criteria.

Keywords

Cutaneous polyarteritis nodosa Clinical entity Definition Diagnostic criteria Extracutaneous symptoms 

Notes

Acknowledgments

We are grateful to the following dermatologists for their cooperation in providing information on CPN patients and providing answer to our questionnaires; Hiroyuki Okamoto, MD (Kansai Medical University), Atsushi Utani, MD (Kyoto University), Yayoi Nagai, MD (Gunma University), Osamu Yamasaki, MD (Okayama University), Taisuke Itoh, MD (Hamamatsu University School of Medicine), Takatoshi Shimauchi, MD (University of Occupational and Environmental Health), Toshiyuki Yamamoto, MD*, Yumiko Furuhata, MD (Tokyo Medical University), Ko-Ron Chen, MD (Saiseikai Central Hospital), Tamihiro Kawakami, MD (St. Marianna University School of Medicine), Naoko Ishiguro, MD (Tokyo Women’s Medical University), Setsuya Aiba, MD (Tohoku University), Kensei Katsuoka, MD (Kitasato University), Mikio Masuzawa, MD (Kitasato University), Seiji Kawana, MD (Nippon Medical School), Shinichi Sato, MD (Nagasaki University), Eishin Morita, MD (Shimane University), Seiichi Izaki, MD (Saitama Medical University). * Currently at the Department of Fukushima Medical University.

Conflict of interest statement

The authors have no potential conflict of interest.

References

  1. 1.
    Barham KL, Jorizzo JL, Grattan B, Cox NH (2004) Cutaneous polyarteritis nodosa. In: Tony B, Stephen B, Neil C, Christopher G (eds) Rook’s textbook of dermatology, 7th edn. Blackwell Science, UK, pp 49.23–49.24Google Scholar
  2. 2.
    Borrie P (1972) Cutaneous polyarteritis nodosa. Br J Dermatol 87:87–95. doi: 10.1111/j.1365-2133.1972.tb16181.x PubMedCrossRefGoogle Scholar
  3. 3.
    Chen KR (2006) Polyarteritis nodosa. In: Miyagawa S (ed) Collagen diseases diagnosed by skin lesions. zen-nihonbyoin shuppan kai, Tokyo, pp 90–98 (in Japanese)Google Scholar
  4. 4.
    Chen KR (1989) Cutaneous polyarteritis nodosa: A clinical and histological study of 20 cases. J Dermatol 16:429–442PubMedGoogle Scholar
  5. 5.
    Cohen RD, Conn DL, Ilstrup DM (1980) Clinical features, prognosis, and response to treatment in polyarteritis. Mayo Clin Proc 55:146–155PubMedGoogle Scholar
  6. 6.
    Daoud MS, Hutton KP, Gibson LE (1997) Cutaneous periarteritis nodosa: a clinicopathological study of 79 cases. Br J Dermatol 136:706–713. doi: 10.1111/j.1365-2133.1997.tb03656.x PubMedCrossRefGoogle Scholar
  7. 7.
    Diaz-Perez JL, Winkelmann RK (1974) Cutaneous periarteritis nodosa. Arch Dermatol 110:407–414. doi: 10.1001/archderm.110.3.407 PubMedCrossRefGoogle Scholar
  8. 8.
    Goodless DR, Dhawan SS, Alexis J, Wiszniak J (1990) Cutaneous periarteritis nodosa. Int J Dermatol 29:611–615. doi: 10.1111/j.1365-4362.1990.tb02580.x PubMedCrossRefGoogle Scholar
  9. 9.
    Gushi A, Hashiguchi T, Fukumaru K, Usuki K, Kanekura T, Kanzaki T (2000) Three Cases of Polyarteritis Nodosa Cutanea and a Review of the Literature. J Dermatol 27:778–781PubMedGoogle Scholar
  10. 10.
    Kawakami T, Yamazaki M, Mizoguchi M, Soma Y (2007) High titer of anti-phosphatidylserine-prothrombin complex antibodies in patients with cutaneous polyarteritis nodosa. Arthritis Rheum 57:1507–1513. doi: 10.1002/art.23081 PubMedCrossRefGoogle Scholar
  11. 11.
    Lightfoot RW Jr, Michel BA, Bloch DA et al (1990) The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 33:1088–1093PubMedGoogle Scholar
  12. 12.
    Lindberg K (1931) Ein Beitrag zur Kenntnis der Periarteriitis nodosa. Acta Med Scand 76:183–225Google Scholar
  13. 13.
    Thomas RH, Black MM (1983) The wide clinical spectrum of polyarteritis nodosa with cutaneous involvement. Clin Exp Dermatol 8:47–59. doi: 10.1111/j.1365-2230.1983.tb01744.x PubMedCrossRefGoogle Scholar
  14. 14.
    Minkowitz G, Smoller BR, McNutt NS (1991) Benign cutaneous polyarteritis nodosa. Relationship to systemic polyarteritis nodosa and to hepatitis B infection. Arch Dermatol 127:1520–1523. doi: 10.1001/archderm.127.10.1520 PubMedCrossRefGoogle Scholar
  15. 15.
    Moreland LW, Ball GV (1991) Cutaneous polyarteritis nodosa. Am J Med 88:426–430. doi: 10.1016/0002-9343(90)90502-5 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Tomoyuki Nakamura
    • 1
  • Nobuo Kanazawa
    • 1
  • Takaharu Ikeda
    • 1
  • Yuki Yamamoto
    • 1
  • Kimimasa Nakabayashi
    • 2
  • Shoichi Ozaki
    • 3
  • Fukumi Furukawa
    • 1
  1. 1.Department of Dermatology, School of MedicineWakayama Medical UniversityWakayamaJapan
  2. 2.First Department of Internal MedicineKyorin University School of MedicineTokyoJapan
  3. 3.Division of Rheumatology and Allergy, Department of Internal MedicineSt. Marianna University School of MedicineKanagawaJapan

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