• Vol. 41 No. 9, 400–406
  • 15 September 2012

A Ten-Year Retrospective Study on Livedo Vasculopathy in Asian Patients

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ABSTRACT

Introduction: This study aims to analyse the clinico-epidemiological characteristics of Asian patients diagnosed with livedo vasculopathy (LV).

Materials and Methods: We performed a retrospective analysis of all patients diagnosed with LV from 1997 to 2007 at our centre.

Results: Seventy patients were diagnosed with LV with a mean age of 39 years, female: male ratio of 3:1 and no racial predilection. Most cases remained purely cutaneous, presenting with painful leg ulcers and atrophie blanche. Peripheral neuropathy was the only extra-cutaneous complication (9%). In patients who were screened, associations included hepatitis B (7%) and hepatitis C (4%), positive anti-nuclear antibody (14%), positive anti-myeloperoxidase antibody (5%), positive anti-cardiolipin antibodies (7%) and positive lupus anticoagulant (2%). In 49 patients who achieved remission, 55% required combination therapy, most commonly with colchicine, pentoxifylline and prednisolone. In those treated successfully with monotherapy, colchicine was effective in 59% followed by prednisolone (17.5%), pentoxifylline (17.5%) and aspirin (6%). Mean follow-up period was 50 months.

Conclusion: LV in Asian patients is a high morbidity, chronic relapsing ulcerative skin condition. Most patients require induction combination therapy for remission. As further evidence emerges to support a procoagulant pathogenesis, a standardised protocol is needed to investigate for prothrombotic disorders during diagnosis.


Livedo vasculopathy (LV), previously referred to as livedo vasculitis or atrophie blanche, is a chronic, recurrent disease, which was first described by Feldaker et al in 1955 as “livedo reticularis with summer ulcerations”. It usually presents as recurrent, painful, deep punched-out ulcers on the lower extremities, which heal with stellate, porcelain-white scars, known as atrophie blanche. Net-like reticulated erythema, such as livedo racemosa or livedo reticularis, is often also associated with LV. The exact aetiology of LV still remains unknown although the disease is now widely believed to likely have a procoagulant pathogenesis. This retrospective study aims to analyse the demographics, comorbidities, clinicopathological features, laboratory findings and treatment outcomes of LV patients seen over a 10-year period at a tertiary dermatology referral centre, in order to further understand the clinico-epidemiological features of this disease in Asians and to refi ne our treatment strategies based on documented clinical outcomes

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