Update of management of connective tissue diseases: livedoid vasculopathy

Abstract

: Livedoid vasculopathy (LV) is characterized by painful purple macules and papules that subsequently ulcerate. The lesions heal over weeks to months resulting in smooth, porcelain‐white, atrophic plaque‐like areas with surrounding telangiectases and hyperpigmentation. The specific cause of LV is still to be determined and it is believed to be multifactorial in nature. Despite numerous available therapeutic agents, there is not a single best efficacious treatment for LV. Most of the available treatment options are based on isolated case reports or case series. In this article, studies on the pathogenesis and therapeutic approaches to LV are reviewed.

Efficacy of new low-dose oral anticoagulants in recalcitrant livedoid vasculopathy

“…Livedoid vasculopathy (LV) is a recurrent, chronic skin disease first described by Bard and Winkelmann in 1967 and characterised by painful purpuric macules on the legs and feet, which often ulcerate and leave white atrophic scarring after healing 1. The main pathogenic mechanism is considered to be intraluminal thrombosis of dermal venules resulting in vaso-occlusion and subsequent tissue hypoxia 1.…”

“…The main pathogenic mechanism is considered to be intraluminal thrombosis of dermal venules resulting in vaso-occlusion and subsequent tissue hypoxia 1. LV is generally treated by the administration of antiplatelets and anticoagulants, including aspirin and warfarin; however, such treatment is controversial and often ineffective.…”

Rezidivierende Ulzerationen bei Livedovaskulopathie

“…In der direkten Immunfluoreszenz finden sich in manchen Fällen Ablagerungen von Immunkomplexen, Fibrin und Komplement im Bereich der Gefäßwände. Diese sind jedoch unspezifisch [5,6]. Der Krankheitsverlauf der Patienten wird typischerweise als chronisch-rezidivierend, mit teilweise jahre-bis jahrzehntelangen erscheinungsfreien Intervallen beschrieben [7].…”

“…Hautbefund an beiden Unterschenkeln bei der Verlaufskontrolle 4 Wochen nach Entlassung mit vollständiger Abheilung aller Ulzerationen.der Behandlung der Livedovaskulopathie beschrieben werden[5]. Als adjuvante Maßnahmen werden Nikotinkarenz und ggf.…”

Livedoid vasculopathy as a marker of systemic disease: report of two cases

“…1 In 1967, Bard and Winkelman reported livedoid vasculopathy in patients with segmental hyalinizing alteration of small dermal vessels. 2 For a long time, the term "livedoid vasculitis" was used as a synonym of the disease, but it is no longer accepted, for findings compatible with vasculitis are not present in the histological exam. 3 Two cases with painful ulcerated lesions on the lower limbs are reported, in which the identification of VL enabled the diagnosis of systemic diseases.…”