Livedoid vasculopathy managed with hyperbaric oxygen therapy

Abstract

Livedoid vasculopathy Atrophie blanche a b s t r a c tLivedoid vasculopathy is an uncommon condition resulting in painful lower extremity ulceration and scarring. This condition presents as purpuric macules and papules that progress to painful, irregular ulcers of the lower legs and dorsal feet. These ulcerations are often recurrent and chronic with spontaneous remissions and exacerbations that may be seasonal.The first case, a 22-year-old female presented with three-year history of recurrent multiple non-healing ulcers involving feet and ankles. The ulcers were associated with severe debilitating pain and paraesthesia, as a result of which she was unable to walk without support. Patient was administered HBOT at pressure of 2.5ATA for 1 h daily, six days a week. After ten sittings of HBOT, patient reported a drastic reduction in the pain along with reduction in the dose of analgesic by half and a definite improvement in her walking. The second case was a 49-year-old male who also had history of recurrent ulceration on the dorsum of feet and ankles associated with severe pain. With HBOT, the patient felt an improvement in pain and ambulation by the 8th sitting and complete relief from pain by the 17th sitting.HBOT is a recognized modality of treatment of various problem wounds and nonhealing ulcers due to various etiologies. The above two cases show that it can be a useful treatment modality for livedoid vasculopathy where other treatment modalities have failed and therefore could be given to a larger number of patients in hospitals where it is available. ª

From dermatological conditions toCOVID‐19: Reasoning for anticoagulation, suppression of inflammation, and hyperbaric oxygen therapy

“…In 2003, Yang et al 4 described two patients with an intractable LV whose ulcers were successfully treated with HBOT. After this, other authors published case reports with similarly satisfactory results in LV patients 5‐11 …”

“…After this, other authors published case reports with similarly satisfactory results in LV patients. [5][6][7][8][9][10][11] In February 2020, Zhong et al 12 described the first case report of successful HBOT in a severely ill COVID-19 patient who was failing standard respiratory support (not intubated) and whose disease course was reversed with eight HBOT sessions at 200 kPa over a total treatment time of 95 minutes. Subsequently, Chen et al 13 reported five severe or moderate acute respiratory distress syndrome (ARDS) patients with COVID-19 pneumonia who had been treated under HBOT.…”

Pain Management Options in a Patient with Livedoid Vasculopathy and Peripheral Neuropathy

“…Antiplatelets like aspirin, pentoxifylline and dipyridamole remain the first-line therapeutic options along with rivaroxaban, warfarin and low-molecular-weight heparin in associated thrombophilia [ 1 , 5 ] . Second-line therapeutic options include anabolic steroids, intravenous immunoglobulins and hyperbaric oxygen [ 5 , 9 ] . Third-line options in resistant cases include hydroxychloroquine in systemic lupus erythematosus and APLA, oral colchicine or dapsone in vasculitis [ 5 ] .…”

German S1 guideline: diagnosis and treatment of livedovasculopathy

“…Some relapses occurred after about six months [58]. In summary, hyperbaric oxygen therapy is time-consuming and expensive, but rapid pain relief and clinical improvement were achieved [59]. Available reports also show that therapeutic success was short-lived in some cases [58,60].…”