title: Livedoid vasculopathy: further evidence for procoagulant pathogenesis.
abstract: 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.
authors.affiliation: Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Bethany R
authors.initials: BR
authors.lastname: Hairston
authors.forename: Mark D P
authors.initials: MD
authors.lastname: Davis
authors.forename: Mark R
authors.initials: MR
authors.lastname: Pittelkow
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmed
mesh_terms: 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
chemical_list: D017153:Antibodies, Anticardiolipin