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Ronicke M, Berking C, Erfurt-Berge C. Occlusive cutaneous vasculopathies as cause of chronic ulcers. J Dtsch Dermatol Ges 2024; 22:553-567. [PMID: 38379266 DOI: 10.1111/ddg.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/15/2023] [Indexed: 02/22/2024]
Abstract
The term occluding vasculopathies covers a large number of different conditions. These often manifest as skin ulcers. Occluding vasculopathies should be considered in the differential diagnosis of leg ulcers. The term "occlusive vasculopathies" encompasses pathophysiologically related entities that share structural or thrombotic obliteration of small cutaneous vessels. In this article, we will focus on livedoid vasculopathy with and without antiphospholipid syndrome and calciphylaxis with differentiation from hypertonic leg ulcer as the most relevant differential diagnoses of leg ulcer. The term also includes vascular occlusion, for example due to oxalate or cholesterol embolism, and septic vasculopathy. This often leads to acral ulceration and is therefore not a differential diagnosis with classic leg ulcers. It will not be discussed in this article. Occlusive vasculopathy may be suspected in the presence of the typical livedo racemosa or (non-inflammatory) retiform purpura as a sign of reduced cutaneous perfusion in the wound area. Inflammatory dermatoses, especially vasculitides, must be differentiated. This is achieved by histopathological evaluation of a tissue sample of sufficient size and depth taken at the appropriate time. In addition, specific laboratory parameters, particularly coagulation parameters, can support the diagnosis.
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Affiliation(s)
- Moritz Ronicke
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Ronicke M, Berking C, Erfurt-Berge C. Okkludierende kutane Vaskulopathien als Ursachen chronischer Unterschenkelulzerationen. J Dtsch Dermatol Ges 2024; 22:553-568. [PMID: 38574010 DOI: 10.1111/ddg.15276_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/15/2023] [Indexed: 04/06/2024]
Abstract
ZusammenfassungUnter den Begriff der okkludierenden Vaskulopathien fällt eine Reihe unterschiedlicher Krankheitsbilder. Diese manifestieren sich an der Haut häufig mit Ulzerationen. Gerade bei Ulzerationen der Unterschenkel sollten okkludierende Vaskulopathien in die differenzialdiagnostischen Überlegungen einbezogen werden. Der Begriff „okkludierende Vaskulopathien“ umfasst pathophysiologisch verwandte Entitäten, die eine strukturelle oder thrombotische Obliteration von kleinsten Hautgefäßen gemein haben. In diesem Artikel wird vor allem auf die Livedovaskulopathie mit und ohne Antiphospholipidsyndrom sowie die Calciphylaxie mit Abgrenzung zum Ulcus cruris hypertonicum als die relevantesten Differenzialdiagnosen von Unterschenkelulzerationen eingegangen. Der Begriff umfasst auch Gefäßverschlüsse, beispielsweise durch Oxalat oder Cholesterinembolie, sowie die septische Vaskulopathie. Diese führt häufig zu akralen Ulzerationen und stellt somit keine Differenzialdiagnose zum klassischen Ulcus cruris dar. Sie wird daher in diesem Artikel nicht behandelt.Der Verdacht einer okkludierenden Vaskulopathie kann über die typische Livedo racemosa beziehungsweise die (nichtinflammatorische) retiforme Purpura als Zeichen der kutanen Minderdurchblutung in der Wundumgebung gestellt werden. Entzündliche Dermatosen, insbesondere Vaskulitiden, müssen differenzialdiagnostisch abgegrenzt werden. Dies geschieht zum Teil klinisch und durch die histopathologische Beurteilung einer Gewebeprobe, die in ausreichender Größe und Tiefe sowie zum richtigen Zeitpunkt entnommen werden muss. Ergänzend können spezifische Laborparameter, insbesondere die Gerinnungsdiagnostik, die Diagnosestellung unterstützen.
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Affiliation(s)
- Moritz Ronicke
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
- Deutsches Zentrum für Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
- Deutsches Zentrum für Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Cornelia Erfurt-Berge
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
- Deutsches Zentrum für Immuntherapie (DZI), Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
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Burg MR, Mitschang C, Goerge T, Schneider SW. Livedoid vasculopathy - A diagnostic and therapeutic challenge. Front Med (Lausanne) 2022; 9:1012178. [PMID: 36262273 PMCID: PMC9574051 DOI: 10.3389/fmed.2022.1012178] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 01/09/2023] Open
Abstract
Livedoid vasculopathy is a rare, chronic-recurrent occlusive disorder in the microcirculation of dermal vessels. The clinical appearance is characterized by Livedo racemosa, painful ulceration, located in the distal parts of the lower extremities, followed by healing as porcelain-white, atrophic scars, the so-called Atrophie blanche. Different conditions that can promote a hypercoagulable state, such as inherited and acquired thrombophilias, autoimmune connective-tissue diseases and neoplasms, can be associated with livedoid vasculopathy. Therefore, livedoid vasculopathy is currently considered to be a coagulation disorder, clearly distinguished from inflammatory vasculitis. Although there are hints to hypercoaguability and secondary inflammation, pathophysiology is not completely understood. Diagnosis is made by synopsis of history, clinical and histopathological findings. Early and adequate therapy is essential to maintain life quality and avoid irreversible complications. Better understanding of molecular mechanisms is required to establish appropriate therapy regimens. This article presents the current state of knowledge about livedoid vasculopathy and proposes an algorithmic approach for diagnosis and therapy.
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Affiliation(s)
- Maria Rosa Burg
- Department of Dermatology and Venereology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Carolin Mitschang
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - Tobias Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany,*Correspondence: Tobias Goerge,
| | - Stefan Werner Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg Eppendorf, Hamburg, Germany,Stefan Werner Schneider,
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Schiffmann ML, Dissemond J, Erfurt-Berge C, Hafner J, Itzlinger-Monshi BA, Jungkunz HW, Kahle B, Kreuter A, Scharffetter-Kochanek K, Lutze S, Rappersberger K, Schneider SW, Strölin A, Sunderkötter C, Goerge T. S1-Leitlinie Diagnostik und Therapie der Livedovaskulopathie. J Dtsch Dermatol Ges 2021; 19:1667-1678. [PMID: 34811901 DOI: 10.1111/ddg.14520_g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | | | - Birgit Kahle
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | | | | | | | | | | | | | | | - Tobias Goerge
- Klinik für Hautkrankheiten, Universitätsklinik Münster
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Schiffmann ML, Dissemond J, Erfurt-Berge C, Hafner J, Itzlinger-Monshi BA, Jungkunz HW, Kahle B, Kreuter A, Scharffetter-Kochanek K, Lutze S, Rappersberger K, Schneider SW, Strölin A, Sunderkötter C, Goerge T. German S1 guideline: diagnosis and treatment of livedovasculopathy. J Dtsch Dermatol Ges 2021; 19:1668-1678. [PMID: 34739187 DOI: 10.1111/ddg.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | - Birgit Kahle
- University Hospital Schleswig-Holstein, Campus Lübeck
| | | | | | | | | | | | | | | | - Tobias Goerge
- Department of Skin Diseases, University Hospital Münster
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Klingelhöller C, Schneider SW. Differentialdiagnose Ulcus cruris, Ursachen und Therapie. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1584-5841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie ätiologisch korrekte Diagnose eines Ulcus cruris zu stellen ist nicht immer einfach und sollte insbesondere bei chronischen progredienten Wunden differenzialdiagnostisch gut überlegt sein. Neben den häufigsten Ursachen des Ulcus cruris, den Gefäßerkrankungen, sind auch z.B. autoimmunologische, infektiöse, metabolische, exogene und neoplastische Ursachen in die differenzialdiagnostischen Überlegungen mit einzubeziehen. Für eine erfolgreiche Behandlung der Patienten mit chronischen Wunden mit gleichzeitiger, deutlich reduzierter Lebensqualität ist eine kausale Therapie zwingend notwendig.
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Affiliation(s)
- Carmen Klingelhöller
- Klinik und Poliklinik für Dermatologie, Andrologie und Venerologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Stefan W. Schneider
- Klinik und Poliklinik für Dermatologie, Andrologie und Venerologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
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Kofler K, Strölin A, Geiger V, Kofler L. Intravenous Immunoglobulin Therapy in Livedoid Vasculopathy: Retrospective Observation of Clinical Outcome and Patient's Activity Level. J Cutan Med Surg 2021; 25:504-510. [PMID: 33779349 PMCID: PMC8474298 DOI: 10.1177/12034754211003525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Livedoid vasculopathy (LV) is a rare disease characterized by livedo
racemosa, atrophie blanche, ulcerations, and severe pain. Low molecular
weight heparins and rivaroxaban can be used in LV-patients. In addition,
intravenous immunoglobulins (IVIG) have been described as
treatment-option. Objectives Objective was to investigate the therapeutic effect of IVIG on ulcer, pain
and restrictions in daily life. Methods Thirty-two LV-patients who received IVIG at the Department of Dermatology
Tübingen between 01/2014 and 06/2019 were identified. Twenty-five of these
patients were available for further follow up and were included in the
study. Patients were interviewed using a questionnaire focusing on the
course of the disease, symptoms, and subjective response to
IVIG-treatment. Results Twenty-five patients were included in the study (mean follow up: 28.9
months). Patients received an average of 6.8 cycles (range 1-45) of IVIG
during the observed period. Significant improvements were seen regarding skin findings, pain, and
limitation of daily activities. Complete remission of symptoms was observed
in 68% of patients. Good tolerability of IVIG was shown in 92%. Conclusions A good therapy response regarding ulceration, pain, and daily life
restrictions with good tolerability was demonstrated for IVIG (2 g/kg
bodyweight over 5 days).
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Affiliation(s)
- Katrin Kofler
- 9188 Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - Anke Strölin
- 9188 Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - Vanessa Geiger
- 9188 Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - Lukas Kofler
- 9188 Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
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Lee J, Cho S. Livedoid vasculopathy in Koreans: clinical features and response to rivaroxaban treatment. J Eur Acad Dermatol Venereol 2020; 34:e176-e178. [DOI: 10.1111/jdv.16129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J.S. Lee
- Department of Dermatology Seoul Metropolitan Government ‐ Seoul National University Boramae Medical Center Seoul Korea
| | - S. Cho
- Department of Dermatology Seoul Metropolitan Government ‐ Seoul National University Boramae Medical Center Seoul Korea
- Department of Dermatology Seoul National University College of Medicine Seoul Korea
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Dissemond J, Erfurt-Berge C, Goerge T, Kröger K, Funke-Lorenz C, Reich-Schupke S. Systemische Therapien des Ulcus cruris. J Dtsch Dermatol Ges 2019; 16:873-892. [PMID: 29989366 DOI: 10.1111/ddg.13586_g] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
| | | | - Tobias Goerge
- Klinik für Hautkrankheiten, Abteilung für Wundheilung/Phlebologie, Universitätsklinikum Münster
| | - Knut Kröger
- Klinik für Gefäßmedizin, Angiologie, HELIOS Klinikum Krefeld
| | - Carolin Funke-Lorenz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen
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Dissemond J, Erfurt-Berge C, Goerge T, Kröger K, Funke-Lorenz C, Reich-Schupke S. Systemic therapies for leg ulcers. J Dtsch Dermatol Ges 2019; 16:873-890. [PMID: 29989361 DOI: 10.1111/ddg.13586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/12/2018] [Indexed: 02/06/2023]
Abstract
Successful management of patients with leg ulcers requires identification of the underlying etiology, with subsequent initiation of causal treatment, if feasible. Supplementary measures of first choice include stage-adjusted wound treatment, usually combined with compression therapy. The significance of systemic drugs has been the subject of controversial debate, depending on the underlying cause of the condition. The present review article is therefore meant to highlight current aspects of systemic drug therapies for the treatment of leg ulcers associated with chronic venous insufficiency, peripheral arterial disease, livedoid vasculopathy, vasculitis, necrobiosis lipoidica, calciphylaxis and pyoderma gangrenosum. In summary, the majority of therapeutic options presented herein are used off-label. While systemic drugs are promising options for the more common types of wounds such as venous, mixed or arterial leg ulcers, they do not represent the current standard of treatment. By contrast, systemic agents play a key role in the management of many of the other disorders presented herein. These agents primarily include immunomodulatory and rheological drugs used to expedite wound healing.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Cornelia Erfurt-Berge
- Department of Dermatology, Venereology and Allergology, University Medical Center Erlangen, Erlangen, Germany
| | - Tobias Goerge
- Department of Dermatology, Division of Wound Healing/Phlebology, University Medical Center Münster, Münster, Germany
| | - Knut Kröger
- Department of Vascular Medicine, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Carolin Funke-Lorenz
- Department of Dermatology, Venereology and Allergology, University Medical Center Essen, Essen, Germany
| | - Stefanie Reich-Schupke
- Department of Dermatology, Venereology and Allergology, University Medical Center Bochum, Bochum, Germany
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Weishaupt C, Strölin A, Kahle B, Kreuter A, Schneider SW, Gerss J, Eveslage M, Drabik A, Goerge T. Characteristics, risk factors and treatment reality in livedoid vasculopathy - a multicentre analysis. J Eur Acad Dermatol Venereol 2019; 33:1784-1791. [PMID: 31009111 DOI: 10.1111/jdv.15639] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. OBJECTIVE The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well-defined patient cohort. METHODS The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. RESULTS Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female-to-male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5-68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56-70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti-inflammatory regimens were, although often used (17/24), not effective (0/17). CONCLUSION We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012-000108-13-DE).
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Affiliation(s)
- C Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - A Strölin
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - B Kahle
- Department of Dermatology, University Hospital Luebeck, Luebeck, Germany
| | - A Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - S W Schneider
- Department of Dermatology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - J Gerss
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - M Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - A Drabik
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - T Goerge
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
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Russ P, Russwurm M, Kortus-Goetze B, Hoyer J, Kamalanabhaiah S. Phenprocoumon based anticoagulation is an underestimated factor in the pathogenesis of calciphylaxis. BMC Nephrol 2019; 20:114. [PMID: 30940121 PMCID: PMC6444830 DOI: 10.1186/s12882-019-1301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background Calciphylaxis is a life threatening complication in renal patients. Of great importance is the identification of concomitant factors for calciphylaxis. Due to the variability of clinical presentation the evaluation of such factors may be obscured when calciphylaxis diagnosis is based just on clinical features. We aimed to characterize associated factors only in patients with calciphylaxis proven by histomorphological parameters in addition to clinical presentation. Methods In a single center retrospective study we analyzed 15 patients in an 8 year period from 2008 to 2016. Only patients with clinical features and histomorphological proof of calciphylaxis were included. Criteria for histological diagnosis of calciphylaxis were intimal hyperplasia, micro thrombi or von Kossa stain positive media calcification. Results The mean age of patients was 64.8 years. Nine patients (60%) were female; 12 (80%) were obese with a Body-Mass-Index (BMI) > 30 kg/m2; 3 (20%) had no renal disease; 12 (80%) had CKD 4 or 5 and 10 (66.7%) had end-stage renal disease (ESRD). One-year mortality in the entire cohort was 73.3%. With respect to medication history, the majority of patients (n = 13 (86.7%)) received vitamin K antagonists (VKA); 10 (66.7%) were treated with vitamin D; 6 (40%) had oral calcium supplementation; 5 (33.3%) had been treated with corticosteroids; 12 (80%) were on proton pump inhibitors (PPI); 13 (86.7%) patients had a clinical proven hyperparathyroidism. Ten (66.7%) patients presented with hypoalbuminemia at diagnosis. Conclusions The evaluation of biopsy proven calciphylaxis demonstrates that especially treatment with vitamin K antagonists and liver dysfunction are most important concomitant factors in development of calciphylaxis. As progression and development of calciphylaxis are chronic rather than acute processes, early use of DOACs instead of VKA might be beneficial and reduce the incidence of calciphylaxis.
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Affiliation(s)
- Philipp Russ
- Department of Nephrology, University Hospital of Marburg, UKGM GmbH, Baldingerstraße 1, 35033, Marburg, Germany
| | - Martin Russwurm
- Department of Nephrology, University Hospital of Marburg, UKGM GmbH, Baldingerstraße 1, 35033, Marburg, Germany
| | - Birgit Kortus-Goetze
- Department of Nephrology, University Hospital of Marburg, UKGM GmbH, Baldingerstraße 1, 35033, Marburg, Germany
| | - Joachim Hoyer
- Department of Nephrology, University Hospital of Marburg, UKGM GmbH, Baldingerstraße 1, 35033, Marburg, Germany.
| | - Sahana Kamalanabhaiah
- Department of Nephrology, University Hospital of Marburg, UKGM GmbH, Baldingerstraße 1, 35033, Marburg, Germany
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Miguel D, Elsner P, Goetze S. Chronic leg ulcerations associated with livedoid vasculopathy successfully treated with rivaroxaban. Clin Exp Dermatol 2019; 45:120-122. [DOI: 10.1111/ced.13943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- D. Miguel
- Department of Dermatology Jena University Hospital Jena Germany
| | - P. Elsner
- Department of Dermatology Jena University Hospital Jena Germany
| | - S. Goetze
- Department of Dermatology Jena University Hospital Jena Germany
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14
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Wollina U. Dermoscopy of early non-ulcerated livedoid vasculopathy. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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