Livedoid Vasculopathy

Callen, Jeffrey P.

doi:10.1001/archderm.142.11.1481

Cited by 59 publications

(8 citation statements)

References 16 publications

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“…The pathogenesis of LV is cutaneous ischemia and infarction caused by the occlusion of capillary microcirculation 6. Although there are LV-like changes in autoimmune and neoplastic diseases, they develop as secondary lesions 7,8.…”

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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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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“…The causes of cutaneous infarctions are varied, but ultimately follow the known mechanisms of the coagulation cascade. Low-molecular-weight heparins have been shown to be effective in the treatment of livedoid vasculopathy [ 1 , 13 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Livedoid vasculopathy is an orphan skin disease characterized by recurrent thrombosis of the cutaneous microcirculation [ 1 - 6 ]. The disease manifests itself almost exclusively in the ankles, the back of the feet, and the distal part of the lower legs [ 7 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

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A Phase II Multicenter Trial With Rivaroxaban in the Treatment of Livedoid Vasculopathy Assessing Pain on a Visual Analog Scale

Drabik¹,

Hillgruber²,

Goerge³

2014

JMIR Res Protoc

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BackgroundLivedoid vasculopathy is an orphan skin disease characterized by recurrent thrombosis of the cutaneous microcirculation. It manifests itself almost exclusively in the ankles, the back of the feet, and the distal part of the lower legs. Because of the vascular occlusion, patients suffer from intense local ischemic pain. Incidence of livedoid vasculopathy is estimated to be around 1:100,000. There are currently no approved treatments for livedoid vasculopathy, making off-label therapy the only option. In Europe, thromboprophylactic treatment with low-molecular-weight heparins has become widely accepted.ObjectiveThe aim of this trial is the statistical verification of the therapeutic effects of the anticoagulant rivaroxaban in patients suffering from livedoid vasculopathy.MethodsWe performed a therapeutic phase IIa trial designed as a prospective, one-armed, multicenter, interventional series of cases with a calculated sample size of 20 patients. The primary outcome is the assessment of local pain on the visual analog scale (VAS) as an intraindividual difference of 2 values between baseline and 12 weeks.ResultsEnrollment started in December 2012 and was still open at the date of submission. The study is expected to finish in November 2014.ConclusionsLivedoid vasculopathy is associated with increased thrombophilia in the cutaneous microcirculation and the continuous use of anticoagulants helps improve the symptoms. The causes of cutaneous infarctions are heterogenous, but ultimately follow the known mechanisms of the coagulation cascade. Rivaroxaban affects the coagulation cascade and inhibits the factor Xa–dependent conversion of prothrombin to thrombin, thereby considerably reducing the risk of thrombosis.Trial RegistrationTrial Registration EudraCT Number: 2012-000108-13-DE; https://www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:2012-000108-13 (Archived by WebCite at http://www.webcitation.org/6UCktWVCA); German Clinical Trials Register (DRKS): DRKS00004652; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004652 (Archived by WebCite at http://www.webcitation.org/6UCIAKyCS).

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“…Painful skin ulcers and secondary skin changes such as atrophic blanche can be the result of another disorder such as chronic venous insufficiency, vasculitis, pyoderma ganrenosum, and so forth [1]. Some of the conditions associated with LV are presented in Table 2.…”

Section: Discussionmentioning

confidence: 99%

Painless Livedoid Vasculopathy in a Patient with G20210A Prothrombin Gene Mutation

Mirrakhimov

Kho

Ali

2012

Case Reports in Medicine

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87 year old Caucasian female with chronic painless non-healing ulcers over malleoli was admitted to the hospital. On a physical examination, there were two bilateral and laterally located malleoli ulcers with no discharge. A thorough work up was done: lower extremities venous and arterial Doppler ultrasound did not show any evidence of venous and arterial disease respectively. Heterozygous G20210A Prothrombin gene mutation was found, and the patient was started on anticoagulation. This case reports highlights a possibility of a painless livedoid vasculopathy presentation in a patient without significant past thrombotic events. Therefore, it is important to consider livedoid vasculopathy in the differential in a patient with painless ulcerative, atrophic and/or nodular skin lesions over the shins and malleoli.

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Livedoid Vasculopathy

Cited by 59 publications

References 16 publications

Treatment application of rivaroxaban in Chinese patients with livedoid vasculopathy

Treatment application of rivaroxaban in Chinese patients with livedoid vasculopathy

A Phase II Multicenter Trial With Rivaroxaban in the Treatment of Livedoid Vasculopathy Assessing Pain on a Visual Analog Scale

Painless Livedoid Vasculopathy in a Patient with G20210A Prothrombin Gene Mutation

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