Livedoid vasculopathy: A review with focus on terminology and pathogenesis

Clinical and patient reported treatment outcomes of livedoid vasculopathy: a systematic review

Livedoid vasculopathy (LV) is a rare condition affecting the lower extremities, often linked to hypercoagulable states or vascular disorders, and despite increasing treatment options, patients frequently experience suboptimal outcomes. Our systematic review of 44 studies, involving 216 patients, found that rivaroxaban was the most common treatment, with complete (n = 18, 31%) or partial (n = 40, 68%) ulcer healing and complete pain resolution in the 19% reported, while intravenous immunoglobulin also showed promise, although results were mixed. The review highlights the need for further research to identify optimal treatments for LV and establish a standard of care for future clinical trials.

Livedoid vasculopathy, calciphylaxis, and Martorell's hypertensive ulcer: update on ischemic ulcers due to impaired microcirculation of the lower limbs

Ischemic ulcers due to compromised microcirculation of the lower limbs cause painful ulcers that represent a challenge for the correct diagnosis and treatment. Livedoid vasculopathy, calciphylaxis, and Martorell's hypertensive ischemic ulcer are part of this group and present some similarities due to microvascular occlusive impairment. They are often misdiagnosed as inflammatory ulcers such as pyoderma gangrenosum and vasculitis. This review discusses the pathophysiology, risk factors, clinical aspects, differential diagnoses, histopathology, and presents a therapeutic update of livedoid vasculopathy, calciphylaxis, and Martorell's ulcer. Although they are less frequent causes of chronic ulcers, a correct diagnosis is essential to reduce the chance of erroneous therapies that may impact morbidity and mortality related to these conditions.

Livedoid vasculopathy in hemoglobinopathy-associated chronic leg ulcers

Chronic leg ulceration is a debilitating manifestation of hemoglobinopathies, and best management is uncertain. Livedoid vasculopathy (LV) is a cutaneous non-inflammatory thrombotic vasculopathy treated with anticoagulation that has been identified in hemoglobinopathy-associated chronic leg ulceration. However, most patients with hemoglobinopathy-associated ulcers do not undergo workup for secondary causes, and the prevalence and relevance of LV is unclear. Outcomes of secondary workup were examined retrospectively in this study. 108 patients with hemoglobinopathy-associated chronic leg ulcers were identified. 15% of patients underwent skin biopsy, and 97% of biopsies showed non-specific findings. Two patients had LV and neither responded to anticoagulants. Livedoid vasculopathy is a rare cause of ulceration in hemoglobin gene disorders and the benefit of anticoagulation in these cases is unclear.

Dermatologic manifestations of hematologic disorders

Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.

The muscle pump activator device: From evidence to lived experiences

A chronic wound is one that fails to progress through a normal timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after 3 months. The most common chronic wounds include venous, ischaemic and mixed leg ulcers, diabetic foot ulcers and pressure injuries. Chronic wounds place immense physical and psychosocial burden on patients and exact heavy costs for healthcare systems, with many patients continuing to live with chronic wounds even after all management options have been exhausted. The muscle pump activator (MPA) device can be used to bridge this therapeutic gap. By stimulating the common peroneal nerve to activate venous muscle pump of the leg and foot, the MPA device increases blood flow to the lower leg and foot to improve conditions for healing. Currently, evidence in the literature exist to show that the MPA device improves wound outcomes over standard compression therapy, decreases edema and increases wound healing rates. In this review, we also present a series of chronic wound patients treated with the MPA device in multicentre clinics to demonstrate the ability of the MPA device to improve wound outcomes, reduce pain and edema and improve patient quality of life.

Anti-Interleukin 17A Biologic Therapy Attempts on Livedoid Vasculopathy: A Report of Case Series

The application of biologics such as anti-tumor necrosis factor (TNF) has shown great efficacy in livedoid vasculopathy (LV). However, new biological options need to be identified for those with a high tuberculosis reactivation risk. In this study, we evaluated the efficacy of anti-17A biologics for LV therapy. Two patients with LV who were irresponsive to traditional anticoagulation therapy were studied at the outpatient dermatology clinic of Peking Union Medical College Hospital. All patients received anti-17A biological therapy for at least two-four weeks. Both patients reported an exacerbation of the skin lesions, which might indicate that the IL-17 pathway plays a critical role in LV pathogenesis.

Healing refractory livedoid vasculopathy-related skin ulcers by ozone therapy: a case-based review

Chronic skin wounds represent a prominent etiological factor in the occurrence of non-traumatic foot amputations on a global scale and pose a substantial threat to the patient's well-being and mortality in the absence of effective treatment strategies. There exists a subset of patients that exhibit an insufficient response to different treatment options, comprising antibiotics, dressings, gauze bandages, debridement, rehabilitation, collagen patch, and vacuum-assisted closure. In this patient group, distinct treatment strategies emerge before surgery and amputation. Ozone therapy is one of them. Ozone exhibits a wide variety of effects such as antimicrobial, anti-inflammatory, antioxidant, and trophic. Its trophic effect is mediated by disinfection, stimulation of granulation tissue, acceleration of the angiogenesis process, and detoxification mechanisms. In this article, we presented the beneficial effect of ozone therapy in a case of chronic skin ulcer associated with livedoid vasculopathy. In this context, we aimed to discuss the role of ozone therapy in the management of chronic skin ulcers. Finally, we focused on ozone therapy as a promising method in inflammatory rheumatic diseases.