Livedoid Vasculopathy

Hairston, Bethany R.; Davis, Mark D. P.; Pittelkow, Mark R.; Ahmed, Iftikhar

doi:10.1001/archderm.142.11.1413

Cited by 160 publications

(36 citation statements)

References 47 publications

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“…It is more common in women(44). Reported etiologies for LV include autoimmune diseases (45–53), hypercoagulable states and situations with impaired fibrinolysis(54). However, approximately one third of cases are idiopathic.…”

Section: Differential Diagnosis Of Vasculitic Woundsmentioning

confidence: 99%

Vasculitic and autoimmune wounds

Shanmugam

Angra

Rahimi

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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Chronic wounds are a major cause of morbidity and mortality. Approximately 20–23% of non-healing wounds that are refractory to vascular intervention have other etiologies including vasculitis, pyoderma gangrenosum and other autoimmune diseases. The purpose of this article is to review the autoimmune and coagulopathic diseases that are commonly associated with leg ulceration. OBJECTIVES To review the literature across medical and surgical specialties with regards to refractory chronic wounds associated with vasculitis and autoimmune diseases and to delineate clinical outcomes of these wounds in response to vascular and other interventions. METHODS An electronic search encompassing MEDLINE®, PubMed®, Cochrane Library and Scopus ® was completed using the following search terms: rheumatoid arthritis; systemic sclerosis; systemic lupus erythematosus; ANCA associated vasculitis; mixed connective tissue disease; antiphospholipid syndrome; pyoderma gangrenosum; thromboangiitis obliterans; cryoglobulinemia; hydroxyurea; sickle-cell; atrophie blanche; livedoid vasculitis; cholesterol emboli; calciphylaxis; antiphospholipid antibodies; prothrombotic; combined with the terms: chronic wound and leg ulcer. Full text articles published in English up to March 1, 2016 that investigated the clinical outcomes of chronic wounds associated with autoimmune diseases were included. Review articles and evaluations of management of chronic wounds were also reviewed. Primary outcomes included in the review were amputation, ulcer healing, reduction in wound size, overall survival and freedom from reintervention. Owing to the heterogeneity of data reporting among articles, qualitative analysis is also reported. CONCLUSIONS Autoimmune and vasculitic etiologies should be considered in patients with chronic wounds who do not respond to appropriate vascular intervention and standard local wound care. A multidisciplinary approach with the involvement of rheumatology allows investigation for underlying systemic disease and improves clinical outcomes for many of these challenging patients.

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Section: Differential Diagnosis Of Vasculitic Woundsmentioning

confidence: 99%

Vasculitic and autoimmune wounds

Shanmugam

Angra

Rahimi

et al. 2017

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…Atrophie blanche and LV is more common in women (42). Reported etiologies for LV include autoimmune diseases (43–51), hypercoagulable states and situations with impaired fibrinolysis (52). However, approximately one third of cases are idiopathic.…”

Section: Occlusive Diseases Resulting In Ulcersmentioning

confidence: 99%

Vasculitic Diseases and Prothrombotic States Contributing to Delayed Healing in Chronic Wounds

Shanmugam

2016

Curr Derm Rep

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PURPOSE Autoimmune diseases are a common cause of delayed wound healing and should be considered in patients with chronic wounds who do not respond to local wound care or who fail skin grafting in the absence of infection. RECENT FINDINGS Epidemiologic studies have shown that, of patients with chronic wounds evaluated in specialized wound healing clinics, 20–23% have autoimmune etiologies for their wounds including vasculitis, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, pyoderma gangrenosum and other autoimmune diseases. SUMMARY In this article autoimmune diseases known to be associated with chronic wounds and delayed wound healing are reviewed and the importance of a multidisciplinary approach for patients with chronic wounds, with involvement of rheumatology and dermatology is highlighted. This approach allows for investigation of underlying systemic disease and improves clinical outcomes for many of these challenging patients.

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“…Although there are LV-like changes in autoimmune and neoplastic diseases, they develop as secondary lesions 7,8. Perivascular inflammatory infiltration is secondary to the inflammation in an advanced stage and less prominent compared with coagulation function 9. LV is almost exclusively located on both lower limbs, particularly the surrounding region of ankle and dorsal aspect of feet.…”

Section: Discussionmentioning

confidence: 99%

Treatment application of rivaroxaban in Chinese patients with livedoid vasculopathy

Chen

Fan

Wang

et al. 2017

JPR

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Livedoid vasculopathy (LV) is a chronic prothrombotic disease of cutaneous micro-circulation resulting in cutaneous ischemia and infarction. As a rare disease, LV has an estimated incidence of ten cases per million. Not only correct diagnosis but also effective treatments are very difficult for patients with LV. Due to the lack of large-scale studies in this rare disease, LV poses a great challenge to the doctors, and existing treatment has always been an individual attempt with off-label application. The main goals in the treatment of patients with LV are to avoid the repeated occurrence of active cutaneous lesions and prevent painful ulceration and irreversible scarring. The current report describes the cases of three Chinese patients with LV receiving rivaroxaban treatment, an oral direct inhibitor of factor Xa inhibitor, and observes the treatment effect of rivaroxaban during the follow-up. As an injection-free alternative to low-molecular-weight heparin (LMWP) and monitoring-free alternative to warfarin, rivaroxaban improves the quality of life and enhances the compliance of patients. All patients consider rivaroxaban as more tolerable than previous drugs and, therefore, continue the application of rivaroxaban, effectively improving the treatment effect of drugs and successfully avoiding the repeated occurrence of active cutaneous lesions. Treatment application of rivaroxaban in Chinese patients with LV successfully avoids the recurrence of active cutaneous lesions and prevents the progressive ulceration and scarring.

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Livedoid Vasculopathy

Abstract: To further characterize the clinical and pathologic features, disease associations, and laboratory abnormalities of livedoid vasculopathy.

Cited by 160 publications

References 47 publications

Vasculitic and autoimmune wounds

Vasculitic and autoimmune wounds

Vasculitic Diseases and Prothrombotic States Contributing to Delayed Healing in Chronic Wounds

Treatment application of rivaroxaban in Chinese patients with livedoid vasculopathy

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