Management of Cutaneous Polyarteritis Nodosa

Initial Treatment and Maintenance

• The American College of Rheumatology recommends starting prednisone at moderate doses (0.25-0.5 mg/kg/day, typically 10-40 mg/day) combined with azathioprine for initial maintenance regimen in patients with cutaneous Polyarteritis Nodosa 1
• Continue immunosuppressive therapy for at least 18 months after achieving sustained remission, with azathioprine maintained at full therapeutic doses for disease control 1, 2
• The optimal glucocorticoid taper duration should be individualized, but err on the side of slower tapering given the ulcer history, as recommended by the American College of Rheumatology 1, 3

Monitoring and Follow-up

• Serial clinical examinations focusing on new skin lesions, ulcers, or nodules are essential for monitoring patients with cutaneous Polyarteritis Nodosa, as stated by the American College of Rheumatology 1
• The American College of Rheumatology guidelines explicitly state that their recommendations do not apply to isolated cutaneous Polyarteritis Nodosa, and that azathioprine-based regimens are superior for cutaneous disease 1, 4