Livedoid vasculopathy: fast involution after anticoagulant and hyperbaric oxygen therapy

Bollmann, Patrícia Weinschenker; Shimada, Andréa Kazumi; Michalany, Nílceo Schwery; Manhani, Ana Rita; Giglio, Auro del

doi:10.1590/s1679-45082011rc1676

Cited by 6 publications

(14 citation statements)

References 16 publications

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“…Table 3 shows the articles from our review of the literature for studies that reported on anticoagulant treatment in LV patients (4 prospective studies, 2 retrospective studies, and 33 case reports) 2,5‐42 . From 39 studies, 219 patients with 139 (63.5%) females and 80 (36.5%) males were included.…”

Section: Resultsmentioning

confidence: 99%

Livedoid vasculopathy: Clinical course and long‐term outcome in Asian patients with a review of the literature

Rujitharanawong

Chularojanamontri

Trakanwittayarak

et al. 2020

Dermatologic Therapy

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Livedoid vasculopathy (LV) is an uncommon, chronic, and recurrent thrombo‐occlusive vascular disorder. Data specific to LV in Thai population remains scarce. This study aimed to evaluate the clinical course and treatment outcomes of LV in Thai patients, and to perform a literature review for studies that reported on anticoagulant treatment in LV. Seventy‐four patients with a mean age of 37.6 ± 14.7 years were included. The female to male ratio was 5.2:1, and the median follow‐up was 10.5 months. Most patients had primary LV disorder. Forty‐eight patients were improved with treatments, with a median duration of 11.4 months. Combination treatments were commonly used, including anti‐inflammatories, antiplatelets, and immunosuppressants. Add‐on therapy with anticoagulant or psoralen plus ultraviolet‐A (PUVA) led to disease improvement in a majority of the patients treated. Kaplan‐Meier analysis demonstrated that 38.5%, 53.7%, and 57.9% would have disease improvement at 1, 2, and 3 years, respectively. Of 39 studies (n = 219) that reported on anticoagulant treatment in LV, anticoagulant drug was used as monotherapy in 104 patients. The mean duration of anticoagulant treatment was 7.2 ± 3.8 months, which led to disease improvement in 97 patients (93.3%). Bleeding side effect was found in 9 patients (8.7%). The highest incidence of LV was found among females aged 30 to 40 years. Combination therapy with anti‐inflammatory drugs, antiplatelet drugs, and immunosuppressants led to disease improvement. The observed efficacy of add‐on PUVA or anticoagulant is promising and should be further investigated. Further studies are needed to guide the development of an LV management guideline.

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Section: Resultsmentioning

confidence: 99%

Livedoid vasculopathy: Clinical course and long‐term outcome in Asian patients with a review of the literature

Rujitharanawong

Chularojanamontri

Trakanwittayarak

et al. 2020

Dermatologic Therapy

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“…In 2003, Yang et al 4 described two patients with an intractable LV whose ulcers were successfully treated with HBOT. After this, other authors published case reports with similarly satisfactory results in LV patients 5‐11 …”

Section: Hyperbaric Oxygen Therapymentioning

confidence: 88%

From dermatological conditions toCOVID‐19: Reasoning for anticoagulation, suppression of inflammation, and hyperbaric oxygen therapy

Criado

Miot²,

Pincelli

et al. 2020

Dermatologic Therapy

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COVID‐19 generates a complex systemic inflammatory response that can lead to death due to wide macrophage activation, endothelial damage, and coagulation in critically ill patients. SARS‐CoV‐2‐induced lung injury due to inflammatory mediated thrombosis could be similar to the livedoid vasculopathy in the skin, supporting a translational comparison of these clinical settings. In this article, we discuss anticoagulation, suppression of inflammatory response, and hyperbaric oxygen therapy in the context of severe COVID‐19 and livedoid vasculopathy.

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“…Beberapa kondisi yang berhubungan dengan VL adalah seperti insufisiensi kronik vena, penyakit autoimun jaringan ikat, trombofilia turunan maupun didapat, neoplasma, dan idiopatik. 4,5 Penyakit VL merupakan penyakit yang jarang terjadi, sehingga konsensus terapi yang terbaik pada penyakit ini masih belum ada. Pendekatan terapi pada VL bervariasi dengan respons yang juga bervariasi.…”

Section: Pendahuluanunclassified

“…Penting sekali menginvestigasi kemungkinan beberapa penyebab yang berhubungan dengan VL untuk menentukan terapi. 4,6,7 Methotrexate merupakan salah satu modalitas terapi berupa imunosupresan pada kasus vaskulitis. Investigasi awal bahwa methotrexate digunakan sebagai terapi vaskulitis adalah berdasarkan mekanisme aksinya dan hasil dari beberapa laporan kasus.…”

Section: Pendahuluanunclassified

Terapi Methotrexate Pada Pasien Dengan Vaskulopati Livedoid

Lilasari

Brahmanti

Retnani³

2018

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AbstrakPenyakit vaskulopati livedoid (VL) adalah penyakit hialinisasi vaskuler yang jarang terjadi dan ditandai dengan ulkus rekuren, kronik, pada ekstremitas bawah serta livedoid reticularis dan atrophie blanche. Patogenesis penyakit belum jelas sehingga belum ada konsensus terapi untuk VL. Methotrexate suatu bahan imunosupresan merupakan salah satu modalitas terapi untuk vaskulitis. Dilaporkan satu kasus lakilaki usia 21 tahun dengan adanya luka yang nyeri dan berulang sejak 15 tahun lalu. Luka dapat sembuh sendiri dan meninggalkan bercak kecoklatan disertai bercak putih yang mengkilat. Tidak ada penyakit penyerta sistemik lain. Pemeriksaan dermatologik pada kedua cruris dan kedua dorsum pedis didapatkan ulkus multipel, bentuk bulat dan ireguler, batas tegas, disertai dengan livedo reticularis dan atrophie blanche. Terapi awal yang diberikan adalah metilprednisolon 1x16 mg per hari per oral namun dalam 2 minggu terjadi rekurensi berupa 6 ulkus baru. Kemudian diberikan methotrexate 15mg/minggu per oral. Dengan pemberian methotrexate selama 2 minggu didapatkan perbaikan dibanding sebelumnya yaitu hanya 2 ulkus baru yang muncul. Disimpulkan Methotrexate dapat digunakan sebagai terapi alternatif pada vaskulopati livedoid, namun follow-up lebih lanjut tetap diperlukan untuk mengetahui rekurensi.Kata Kunci: methotrexate, vaskulitis, vaskulopati livedoid (VL) METHOTREXATE IN LIVEDOIDVASKULOPATHY PATIENTS AbstractLivedoid vasculopathy (LV) is a rare hyalinizing vascular disease characterized by painful chronic recurrent ulcers at lower extremities accompanied with livedoid reticularis and atrophie blanche. The pathogenesis is not clear yet, so there is no consensus therapy for LV. Methotrexate is one of immunosuppressant agent of modalities therapy for vasculitis. A case of 21 years-old man with painful and recurrent wound since 15 years ago. Wound was self-limited and then appeared brown patch with pearly white patch. No other comorbidities conditions. Dermatological examination at both cruris and both dorsal pedis showed multiple ulcers, round to irregular shape, sharply edge, with livedo reticularis and atrophie blanche. It was given methylprednisolone 1x16 mg per day per oral as initial therapy, but have appeared 6 six of new ulcers after 2 weeks of therapy. Then, it was treated with methotrexate 15 mg/week per oral. Clinical improvement achieved after 2 weeks given with methotrexate based on only 2 new ulcers reappeared. Accordingly, methotrexate (MTX) could be an alternative treatment for livedoid vasculopathy(LV), but further follow up is still needed to determine its recurrence.

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Livedoid vasculopathy: fast involution after anticoagulant and hyperbaric oxygen therapy

Cited by 6 publications

References 16 publications

Livedoid vasculopathy: Clinical course and long‐term outcome in Asian patients with a review of the literature

Livedoid vasculopathy: Clinical course and long‐term outcome in Asian patients with a review of the literature

From dermatological conditions toCOVID‐19: Reasoning for anticoagulation, suppression of inflammation, and hyperbaric oxygen therapy

Terapi Methotrexate Pada Pasien Dengan Vaskulopati Livedoid

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