Livedoid vasculopathy
(Redirected from Atrophie blanche)
Livedoid vasculopathy (LV), also known as livedoid vasculitis or atrophie blanche, is a rare, chronic vascular disorder characterized by recurrent painful ulcerations and purpuric skin lesions, primarily affecting the lower extremities. It is considered a form of thrombotic vasculopathy, leading to occlusion of small dermal blood vessels and tissue necrosis.
Pathophysiology[edit | edit source]
Livedoid vasculopathy is a non-inflammatory thrombotic vasculopathy involving occlusion of small dermal blood vessels. The underlying mechanisms include:
- Hypercoagulability – Increased clotting tendency leading to microvascular thrombosis.
- Endothelial dysfunction – Damage to small blood vessels in the dermis.
- Impaired fibrinolysis – Reduced breakdown of fibrin deposits contributes to ischemia and tissue necrosis.
Common laboratory findings in LV patients may include:
- Elevated D-dimer – Indicative of hypercoagulability.
- Presence of antiphospholipid antibodies – In some cases, suggesting antiphospholipid syndrome.
- Protein C or S deficiency – Leading to prothrombotic states.
Clinical Features[edit | edit source]
Livedoid vasculopathy typically presents with:
- Painful purpuric lesions – Often on the ankles and lower legs.
- Ulcerations with white atrophic scars – Known as atrophie blanche.
- Mottled erythema (livedo racemosa) – Reticulated vascular patterns on the skin.
- Recurrent flares – Periodic exacerbations, often worsened in summer months.
The condition is chronic and relapsing, with ulcer healing leaving stellate white scars that are prone to recurrent breakdown.
Diagnosis[edit | edit source]
Diagnosis is based on:
- Clinical presentation – Characteristic purpuric ulcers and atrophie blanche on the lower legs.
- Doppler ultrasound – To assess microvascular blood flow.
- Skin biopsy findings:
- Fibrin thrombi within dermal blood vessels.
- Absence of leukocytoclastic vasculitis.
- Secondary epidermal necrosis.
Differential Diagnosis[edit | edit source]
Livedoid vasculopathy should be distinguished from:
- Vasculitis – Inflammatory disorders such as leukocytoclastic vasculitis or polyarteritis nodosa.
- Raynaud’s phenomenon – Reversible vasospasm causing cyanosis and ischemia.
- Chronic venous insufficiency – Can cause stasis ulcers but lacks thrombotic features.
- Antiphospholipid syndrome – A hypercoagulable state with thrombotic events.
Treatment and Management[edit | edit source]
Since LV is associated with microvascular thrombosis, treatment focuses on anticoagulation and improving circulation.
Pharmacologic Treatment[edit | edit source]
- Antiplatelet therapy – Aspirin or clopidogrel to reduce platelet aggregation.
- Anticoagulation – Low-molecular-weight heparin or warfarin in patients with hypercoagulability.
- Fibrinolytic therapy – Pentoxifylline or rivaroxaban to enhance microcirculation.
- Pain management – NSAIDs or topical analgesics.
- Wound care – Prevention of secondary infections.
Lifestyle and Supportive Care[edit | edit source]
- Compression therapy – To improve venous circulation.
- Leg elevation – Reduces venous stasis.
- Avoidance of cold exposure – Prevents vasospasm and worsening ischemia.
Prognosis[edit | edit source]
Livedoid vasculopathy is a chronic and relapsing condition with periods of remission and exacerbation. Some patients experience spontaneous resolution, while others require long-term anticoagulation to prevent ulcer recurrence.
Related pages[edit | edit source]
Search WikiMD
Ad.Tired of being Overweight? Try W8MD's physician weight loss program.
Semaglutide (Ozempic / Wegovy and Tirzepatide (Mounjaro / Zepbound) available.
Advertise on WikiMD
WikiMD's Wellness Encyclopedia |
Let Food Be Thy Medicine Medicine Thy Food - Hippocrates |
Translate this page: - East Asian
中文,
日本,
한국어,
South Asian
हिन्दी,
தமிழ்,
తెలుగు,
Urdu,
ಕನ್ನಡ,
Southeast Asian
Indonesian,
Vietnamese,
Thai,
မြန်မာဘာသာ,
বাংলা
European
español,
Deutsch,
français,
Greek,
português do Brasil,
polski,
română,
русский,
Nederlands,
norsk,
svenska,
suomi,
Italian
Middle Eastern & African
عربى,
Turkish,
Persian,
Hebrew,
Afrikaans,
isiZulu,
Kiswahili,
Other
Bulgarian,
Hungarian,
Czech,
Swedish,
മലയാളം,
मराठी,
ਪੰਜਾਬੀ,
ગુજરાતી,
Portuguese,
Ukrainian
Medical Disclaimer: WikiMD is not a substitute for professional medical advice. The information on WikiMD is provided as an information resource only, may be incorrect, outdated or misleading, and is not to be used or relied on for any diagnostic or treatment purposes. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. WikiMD expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. By visiting this site you agree to the foregoing terms and conditions, which may from time to time be changed or supplemented by WikiMD. If you do not agree to the foregoing terms and conditions, you should not enter or use this site. See full disclaimer.
Credits:Most images are courtesy of Wikimedia commons, and templates, categories Wikipedia, licensed under CC BY SA or similar.
Contributors: Prab R. Tumpati, MD