Vasculitis

Some studies affirmed that hormonal contraceptves, sometimes may provoke vasculitis. Since Kussmaul and Maier described the index case of vasculitis in 1866, the field has seen many changes but many mysteries remain ⁽¹⁾.

Vasculitis represent such a heterogeneous group of disorders which may involve small arteries, arterioles, capillaries,and venules ^(2,3).

Cutaneous vasculitis may be confined to the skin or may be part of an associated systemic disease ⁽⁴⁾.

Oral contraceptives (OCs) can affect the skin through their hormonal effects or through iatrogenic effects associated with their toxicity in certain individuals. Toxic effects of OCs are rare but potentially serious; they should be diagnosed early and require permanent termination of OC use. The clinical manifestations are variable and not specific to the medication.

The most frequently reported manifestations are allergic vascularities which may lead to serious renal complications, fixed pigmented erythema, urticaria, and lichenoid eruptions ⁽⁵⁾.

Associations between markers of allergy (eosinophils, IgE and atopy) and hormonal dependent events in women (premenstrual asthma, menopause and oral contraceptive use) have been found ⁽⁶⁾. In women, combined steroid contraceptives caused a decrease in antibody formation and complement levels and exhibited an immunosuppressive effect " in vitro" on lymphocyte activation by nonspecific mitogens.

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In vivo, the immunosuppressive effect on lymphocytes is evident after approximately 2 years of contraceptive use and, remained for several months after discontinuation of the drug. In women with rheumatoid arthritis who used steroid contraceptives, an improvement in symptoms occured; in unaffected women, the risk for acquiring the disease was decreased by half.

There was an improvement in the symptoms of chronic bronchial asthma, but there were also, some cases of allergic manifestations 1 to 2 months after beginning contraceptive use ⁽⁷⁾. Contradictory results were reported on the effect of steroid contraceptives on allergic diseases in women. Clinical manifestation ranging from vessel hypersensitivity and allergic angitis to other forms of vasculitis indistinguishables from classical systemic forms as Wegener's granulomatosis, polyarteritis nodosa or Churg-Strauss syndrome ^(8,9,10).

Half of the patients with Wegener's granulomatosis develop skin lesions due to the systemic vasculitis. Differential diagnostic considerations may present several difficulties and a skin biopsy is necessary for establishing the diagnosis. Antineutrophil cytoplasmic antibodies with antigen specificity for proteinase 3 (PR3-ANCA) supports the diagnosis of Wegener granulomatosis .