Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Editor - "Vasculitis"1. What an appropriate subject for a generalist
journal like the BMJ to review, presenting as it does to so many medical
specialties. In fact the title was misleading as only primary systemic
vasculitides were discussed. Renal aspects were thoroughly covered by the
all nephrology authors, but details on other systems were sparse and
contained inaccuracies.
When discussing Kawasaki's disease the review states that aspirin in low
dose is recommended for thrombocythaemia. It fails to mention that
aspirin is equally important in high dose (30-80 mgs/kg/day) in the early
acute phase,2,3 which anteceeds the thrombocytosis.
In Henoch-Schonlein purpura (HSP), the pathological hallmark is deposition
of immunoglobulin A in the walls of dermal vessels4 and not at the
dermoepidermal junction as Savage et al state1.
Furthermore, we are
unaware of any controlled studies on the use of corticosteroids or
immunosuppression in gut manifestations of HSP where their use is
controversial and must be balanced against their known potential toxicity.
Isolated cutaneous leukocytoclastic vasculitis is often a more serious
disease than the narrow self-limiting drug hypersensitivity reaction
mentioned in the paper. Drug reactions account for only 10% of vasculitic
skin lesions and unfortunately cutaneous leukocytoclastic vasculitis is
more likely to be idiopathic and can be prolonged and recurring5. To make
the diagnosis of primary systemic vasculitis, particularly in
leukocytoclastic vasculitis, requires exclusion of secondary causes. An
outline of the differential diagnosis of secondary causes for vasculitis
and their investigation would have added clinical relevance to the review.
We live in an era of multidisciplinary care. Perhaps the BMJ should adopt
a similar approach when commissioning reviews of cross-specialty subjects
to ensure their content is appropriately broad and clinically relevant.
M Murphy specialist registrar
Department of Dermatology, University of Newcastle, NE2 4HH
AJ Carmichael consultant dermatologist
Department of Dermatology, South Cleveland Hospital, Middlesbrough, TS3
4BW
References
1. Savage COS, Harper L, Cockwell, P, Adu D, Howie AJ. Vasculitis.
BMJ 2000;320:1325-1328.
2. Curtis N. Kawasaki disease. BMJ 1997;315:322-323.
3. Leung DTM, Schlievert PM, Meissner HC. The immunopathogenesis and
management of Kawasaki syndrome. Arthritis Rheum 1998;41(9):1538-1547.
4. Piette WW, Stone MS. A cutaneous sign of IgA-associated small
dermal vessel leukocytoclastic vasculitis in adults (Henoch-Schonlein
purpura). Arch Dermatol. 1989;125:53-56.
Need for multidisciplinary authors of cross-specialty diseases
Editor - "Vasculitis"1. What an appropriate subject for a generalist
journal like the BMJ to review, presenting as it does to so many medical
specialties. In fact the title was misleading as only primary systemic
vasculitides were discussed. Renal aspects were thoroughly covered by the
all nephrology authors, but details on other systems were sparse and
contained inaccuracies.
When discussing Kawasaki's disease the review states that aspirin in low
dose is recommended for thrombocythaemia. It fails to mention that
aspirin is equally important in high dose (30-80 mgs/kg/day) in the early
acute phase,2,3 which anteceeds the thrombocytosis.
In Henoch-Schonlein purpura (HSP), the pathological hallmark is deposition
of immunoglobulin A in the walls of dermal vessels4 and not at the
dermoepidermal junction as Savage et al state1.
Furthermore, we are
unaware of any controlled studies on the use of corticosteroids or
immunosuppression in gut manifestations of HSP where their use is
controversial and must be balanced against their known potential toxicity.
Isolated cutaneous leukocytoclastic vasculitis is often a more serious
disease than the narrow self-limiting drug hypersensitivity reaction
mentioned in the paper. Drug reactions account for only 10% of vasculitic
skin lesions and unfortunately cutaneous leukocytoclastic vasculitis is
more likely to be idiopathic and can be prolonged and recurring5. To make
the diagnosis of primary systemic vasculitis, particularly in
leukocytoclastic vasculitis, requires exclusion of secondary causes. An
outline of the differential diagnosis of secondary causes for vasculitis
and their investigation would have added clinical relevance to the review.
We live in an era of multidisciplinary care. Perhaps the BMJ should adopt
a similar approach when commissioning reviews of cross-specialty subjects
to ensure their content is appropriately broad and clinically relevant.
M Murphy
specialist registrar
Department of Dermatology, University of Newcastle, NE2 4HH
AJ Carmichael
consultant dermatologist
Department of Dermatology, South Cleveland Hospital, Middlesbrough, TS3
4BW
References
1. Savage COS, Harper L, Cockwell, P, Adu D, Howie AJ. Vasculitis.
BMJ 2000;320:1325-1328.
2. Curtis N. Kawasaki disease. BMJ 1997;315:322-323.
3. Leung DTM, Schlievert PM, Meissner HC. The immunopathogenesis and
management of Kawasaki syndrome. Arthritis Rheum 1998;41(9):1538-1547.
4. Piette WW, Stone MS. A cutaneous sign of IgA-associated small
dermal vessel leukocytoclastic vasculitis in adults (Henoch-Schonlein
purpura). Arch Dermatol. 1989;125:53-56.
5. Jennette JC, Falk RJ. Small-vessel vasculitis. N Engl J Med.
1997;337(21):1512-1523.
Competing interests: No competing interests