Livedoid vasculopathy with hyperhomocysteinemia responding to hyperbaric oxygen therapy

Abstract

A 30-year-old male presented to the dermatology department with complaints of multiple ulcers over both legs of 6 years duration. The ulcers had a waxing and waning course with present exacerbation of lesions since 1 month. Dermatological examination revealed multiple ulcers distributed in a reticular pattern over medial and lateral aspects of both lower legs, extensor aspect of both ankles and dorsum of both feet. Multiple interspersed atrophic porcelain white scars were also present. Investigations revealed raised serum homocysteine levels. A skin biopsy from the ulcers showed features of livedoid vasculopathy. Following recurrence of lesions after oral corticosteroid therapy, the patient was given a course of hyperbaric oxygen therapy for the ulcers to which he responded very well. This case is being presented for the novel option of hyperbaric oxygen therapy in livedoid vasculopathy, which by itself is rarely reported in this part of the world.

Treatment for Livedoid Vasculopathy

“…The HBOT delivers 100% oxygen at high pressures (2 to 3 atomic pressure), forcing high concentrations of oxygen to dissolve in plasma and counteract tissue ischemia. [42][43][44][45] In addition, HBOT promotes the release of fibrinolytics from endothelial cells, promotes angiogenesis, and facilitates neovascularization, all of which help the ulcers in LV heal. Several other case reports have described the use of HBOT for LV and reported favorable clinical outcomes.…”

“…Similarly, the mechanism of action of PUVA in LV is not fully understood because the influence of the treatment on the coagulation pathway is limited, but a modulatory implication for the immune response has been suggested. The HBOT delivers 100% oxygen at high pressures (2 to 3 atomic pressure), forcing high concentrations of oxygen to dissolve in plasma and counteract tissue ischemia . In addition, HBOT promotes the release of fibrinolytics from endothelial cells, promotes angiogenesis, and facilitates neovascularization, all of which help the ulcers in LV heal.…”