Livedoid
vasculitis (LV)
LV
is a thrombotic vasculopathy of dermal vessels confined to the lower
extremities and starting mostly in the ankle region.
•
A triad of livedo reticularis, atrophie blanche, and very painful, small
punched-out ulcers that have a very poor tendency for healing
•
Atrophie blanche in LV is clinically indistinguishable from that seen in CVI,
except for varicose veins. LV is a reaction pattern of the skin that often
recurs in winter or summer (livedo reticularis with winter and summer
ulcerations").
•
Histologically, there are fibrin thrombi in small and medium-sized dermal veins
and arteries with wedge-shaped necrosis and hyalinization of the vessel walls
(segmental hyalinizing vasculitis).
•
LV may be idiopathic or may be associated with Sneddon syndrome,
antiphospholipid antibody syndrome, or conditions of hypercoagulability or
hyperviscosity.
•
Treatment: Bed rest, analgesics, low-dose heparin, and platelet aggregation inhibitors.
Pain can be relieved and healing accelerated by systemic glucocorticoids.
Anabolic agents such as danazol and stanozolol have been anecdotally reported
to be effective.
•
Larger ulcers will have to be excised and grafted.
