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September 10, 1982

Chronic, Recurrent Small-Vessel Cutaneous Vasculitis-Reply

JAMA. 1982;248(10):1181. doi:10.1001/jama.1982.03330100021023

In Reply.—  We agree with Dr Callen that a larger sample size would be helpful, as is the case with most clinical studies. However, we disagree that a uniform histological picture is required before one can make conclusions regarding a cutaneous vasculitic syndrome. We have emphasized previously that any vasculitic syndrome requires a clinicopathologic definition, with no single criterion completely characterizing any vasculitic syndrome.1,2 In fact, the spectrum of histological appearance from the acute findings of leukocytoclastic venulitis to the subacute and chronic findings of lymphocytic and mixed cellular infiltrates bespeaks the continuum of disease activity in these patients and is consistent with the acute and recurrent exacerbations superimposed on subacute and chronic lesions that are manifest in these patients. Moreover, in animal models of serum-sickness—induced vasculitis, the pattern of the inflammatory infiltrate may vary from an acute to chronic pattern depending on the timing of the biopsy