Livedoid vasculopathy: An in-depth analysis using a modified Delphi approach

Alavi, Afsáneh; Hafner, Jürg; Dutz, Jan P.; Mayer, Dieter; Sibbald, R. Gary; Criado, Paulo Ricardo; Senet, Patricia; Callen, Jeffery P.; Phillips, Tania J.; Romanelli, Marco; Kirsner, Robert S.

doi:10.1016/j.jaad.2013.07.019

Cited by 106 publications

(170 citation statements)

References 55 publications

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“…Some authors did not report on the occurrence of livedo racemosa in LV while others did . The occurrence of livedo racemosa in our study was 82% in LV patients, and its distribution was similar to typical LV lesions.…”

Section: Discussioncontrasting

confidence: 62%

Characteristics, risk factors and treatment reality in livedoid vasculopathy – a multicentre analysis

Weishaupt

Strölin

Kahle³

et al. 2019

Acad Dermatol Venereol

105

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Background Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. Objective The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well‐defined patient cohort. Methods The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. Results Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female‐to‐male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5–68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56–70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti‐inflammatory regimens were, although often used (17/24), not effective (0/17). Conclusion We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012‐000108‐13‐DE).

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Section: Discussioncontrasting

confidence: 62%

Characteristics, risk factors and treatment reality in livedoid vasculopathy – a multicentre analysis

Weishaupt

Strölin

Kahle³

et al. 2019

Acad Dermatol Venereol

105

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“…[1–3] The ulcers are often painful, may heal poorly, and multiple recurrences are common. Fully developed lesions of livedoid vasculopathy are characterized by atrophic plaques with hyperpigmented borders and telangiectactic vessels.…”

Section: Introductionmentioning

confidence: 99%

Dermoscopic features of livedoid vasculopathy

Chen

Lin

et al. 2017

Medicine

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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.

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“…NABOTA â is a botulinum neurotoxin type A (BoNT-A) formulation originated from wild-type Clostridium botulinum. 2,3 After applying topical anaesthetic cream (EMLA â , AstraZeneca AB, S€ odert€ alje, Sweden) about 30 min, 30-gauge insulin syringe with 8 mm length needle was used for the injection. The total dose of botulinum toxin was 50 U for each shoulder (100 U per person).…”

Section: Editormentioning

confidence: 99%