Livedo vasculitis (the vasculitis of atrophie blanche). Immunohistopathologic study

Livedoid Vasculopathy

“…Previous studies have described characteristic thick, intense staining of vessel walls corresponding to hyalinized vessels on hematoxylin-eosin-stained sections. 48 The deposition of these factors, especially fibrin, may be potentially explained by a prothrombic and fibrinolytic state, as has been supported by the finding of elevated fibrinopeptide levels in patients with livedoid vasculopathy. 8 Complement deposition may be a consequence of activation of the coagulation pathway.…”

Treatment of Livedoid Vasculopathy With Low-Molecular-Weight Heparin

“…3 The underlying cause is not yet fully understood; however, the disease has been reported in individuals with altered coagulation, including factor V Leiden mutation, 4 protein C deficiency, 5 antiphospholipid antibody syndrome, 6 increased plasma homocysteine levels, 7 abnormalities in fibrinolysis, 8 and increased platelet activation. 9 Because potential thrombogenic mechanisms may be involved in the disease pathogenesis, 10,11 anticoagulant therapy is often tried.…”

Livedo Vasculopathy vs Small Vessel Cutaneous Vasculitis

“…We did not detect any significant sign of leukocytoclastic vasculitis. Although various reports have revealed the deposition of immunoreactants in blood vessels of patients with LV, 9 the "vasculitic" pathogenesis of this disease has never been sufficiently supported. Numerous investigators consider LV an occlusive vasculopathy.…”

“…5 On the basis of the clinical evolution, the improvement during fibrinolytic and anti- platelet therapy, [6][7][8] and the detection of elevated serum fibrinopeptide A levels, 2 LV is thought to be mediated by a vasocclusive mechanism. Nevertheless, specific histological findings, such as thickened blood vessel walls, occasional deposition of immunoreactants, and fibrin, 9 and the possible association with immune-mediated diseases suggest a potential pathogenetic role of immunological mechanisms. Tissue plasminogen activator treatment was recently reported to be effective in LV.…”