Dermoscopic features of livedoid vasculopathy

Abstract

Livedoid vasculopathy (atrophie blanche) is a form of thrombotic vasculopathy. It is characterized by small ulcers that become crusted, and heal after several months to produce white atrophic scars. The most commonly affected sites are the lower legs, in particular the dorsum of the feet and ankles. To date, the dermoscopic features of livedoid vasculopathy have not been clearly described in the literature. In this observational study, we sought to evaluate the dermoscopic patterns of livedoid vasculopathy and determine whether the dermoscopic features are associated with certain histopathological characteristics. We evaluated 9 patients with livedoid vasculopathy by dermoscopy. Skin biopsy specimens were stained with hematoxylin and eosin for histopathologic examination, and dermoscopic features were correlated with histopathological characteristics. In the majority of patients with livedoid vasculopathy, examination with dermoscopy revealed central crusted ulcers or ivory white areas associated with peripheral pigmentation in a reticular pattern. In addition, increased vascular structures including linear and glomerular vessels were found. On histopathological examination, the central ivory white areas correlated with dermal fibrosis, the reticular pigmentation corresponded to epidermal basal layer hyperpigmentation or melanin within melanophages in the dermal papillae, and the vascular structures correlated with dilatation and proliferation of capillaries in the upper dermis. In summary, the most common dermoscopic features of livedoid vasculopathy identified in this study were central crusted ulcers or ivory white scar-like areas associated with peripheral reticular pigmentation and increased vascular structures. The characterization of dermoscopic criteria for livedoid vasculopathy may improve the accuracy in the clinical diagnosis and follow-up of this disease.

Livedoid vasculopathy – A diagnostic and therapeutic challenge

“…After healing the skin remains atrophic, stellate, scar-like, porcellain-white plaques with teleangiectasia and peripheral hyperpigmentation – the so-called Atrophie blanche ( Figure 7A ; 15 ). Dermatoscopy shows shallow crusted ulcers and ivory white scar-like areas in the center of the lesions and hyperpigmentation in form of reticular pigmentation and increased vascular structures in the periphery of the lesions ( Figure 7B ; 45 , 46 ). Histopathological correlation reveals dermal fibrosis at the center of lesions with ivory white areas in the dermatoscopic picture following the healing of the ulcers.…”

“…The reticular pattern at the periphery is related to hyperpigmentation of the basal layer of the epidermis or melanin within melanophages in the dermal papillae. The vascular structures is correlated with dilatation and proliferation of capillaries in the upper dermis ( 45 ). Lesions of LV are mainly located at the malleolar region or dorsal feet with a bilateral appearance ( Figure 5 ; 13 ).…”

Recognition and Management of Cutaneous Polyarteritis Nodosum Versus Livedoid Vasculitis: A Case Report

“…Prolonged severe ischemia in the skin and hypoxia are thought to stimulate angiogenesis in the surrounding tissues and recruitment of new dermal blood vessels, promoting ulcer formation [8]. Other chronic diseases, such as peripheral vascular disease, may resemble CPAN and other vasculitic conditions due to suspected similar mechanisms and phenotypic mimicry [9].…”

Retiform non-blanchable purpuric plaques in a patient with systemic lupus erythematosus

“…8 In later stages, dense scarring may be found at the dermis level. 9 The presence of neutrophils extending through the vessel walls helps to differentiate vasculitis from LV. 10 Depending on disease severity and patient response, antiplatelet agents (aspirin and dipyridamole), hydroxychloroquine, anticoagulants (warfarin and low-molecular weight heparin), and even tissue plasminogen activator may be used in treatment.…”