Clinical Features and Therapeutic Outcomes of Livedoid Vasculopathy

INTRODUCTIONLivedoid vasculopathy is a relatively uncommon chronic, recurrent occlusive vascular disorder. Previous reports on this condition have largely been based on small retrospective studies.

OBJECTIVESTo analyze epidemiological patterns, clinical manifestations, histopathological features, laboratory parameters, therapeutic interventions, and prognostic outcomes of Chinese patients with livedoid vasculopathy.

METHODSPatients with livedoid vasculopathy diagnosed in a single dermatology center between January 2010 and October 2022 were included for retrospective analysis.

RESULTSA total of 358 patients were included in the study. A female predominance was observed (male-to-female ratio 1:2.4). The mean age at onset was 28.0 ± 15.4 years (median: 23 years), with the highest proportion of patients (149/358, 41.6%) developing symptom onset before age 20 years. The common alternate clinical diagnoses were allergic vasculitis and Henoch-Schönlein purpura. Disease exacerbation during summer occurred in 82.4% (150/183) of patients. Beyond classic symptoms, atypical presentations included pigmented purpuric dermatosis-like lesions (64/358, 17.9%) and stasis dermatitis-like lesions (12/358, 3.4%). Of a total of 409 treatment episodes, 70.7% involved anticoagulation therapy, both as a monotherapy and in combination regimens. During follow-up, 62.3% (147/236) of patients experienced recurrences within two years.

CONCLUSIONSAt our center, livedoid vasculopathy is not uncommon, and affected patients exhibit a substantially younger age at onset. Certain livedoid vasculopathy cases demonstrate atypical clinical presentations, such as pigmented purpuric dermatosis-like lesions or stasis dermatitis-like lesions. In our cohort, the primary therapeutic approaches consist of anticoagulation therapy alone or in combination with other medications. However, these strategies are associated with a high recurrence rate.

Abstract from PubMed