Livedoid vasculopathy: further evidence for procoagulant pathogenesis.
OBJECTIVE
To further characterize the clinical and pathologic features, disease associations, and laboratory abnormalities of livedoid vasculopathy.


METHODS
Retrospective study of patients identified from our institutional database from January 1, 1990, to December 31, 2000.


METHODS
Tertiary care institution. Patients Forty-five patients with biopsy-proved livedoid vasculopathy.


METHODS
Clinical presentation, histopathologic diagnosis, results of testing for coagulation abnormalities, and assessment of vascular status.


RESULTS
Thirty-two patients (71.1%) were female (mean age, 45 years; age range, 10-85 years). Bilateral lower extremity disease occurred in 36 patients (80.0%), ulceration in 31 (68.9%), and atrophie blanche in 32 (71.1%). In patients tested, transcutaneous oximetry measurements were decreased in 20 (74.1%) of 27, and factor V Leiden mutation (heterozygous) was noted in 2 (22.2%) of 9, decreased activity for protein C or protein S in 2 (13.3%) of 15, prothrombin G20210A gene mutation in 1 (8.3%) of 12, and lupus anticoagulant in 5 (17.9%) of 28. Anticardiolipin antibodies were present in 8 (28.6%) of 28 patients, and elevated homocysteine levels in 3 (14.3%) of 21. Intraluminal thrombosis was observed in 44 (97.8%) of 45 skin biopsy specimens. Direct immunofluorescence disclosed multiple vascular conjugates in 31 (86.1%) of 36 biopsy specimens.


CONCLUSIONS
Livedoid vasculopathy was predominantly bilateral, affected the lower extremities, and was associated with ulceration and atrophie blanche. Histologic evidence of intraluminal thrombosis was observed in almost all biopsy specimens reviewed. Laboratory testing revealed numerous heterogeneous coagulation abnormalities, providing further evidence of procoagulant mechanisms.
Hairston
Bethany R
BR
Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
Davis
Mark D P
MD
Pittelkow
Mark R
MR
Ahmed
Iftikhar
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017153:Antibodies, Anticardiolipin / Q000097:blood; D002648:Child; D005260:Female; D005533:Foot Dermatoses / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D006801:Humans; D007871:Leg Ulcer / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017445:Skin Diseases, Vascular / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology
D017153:Antibodies, Anticardiolipin