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A Case of Livedoid Vasculopathy Successfully Treated with Sulodexide

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초록

We report a 29-year-old female with a one-month history of non-healing multiple erythematous to violaceous plaques with crusts over both legs and feet. Tender, scarring ulcers with surrounding erythema were present. The clinical manifestation, together with histopathologic findings of fibrinoid plugs within vascular lumens and walls, as well as red blood cell extravasation, led to diagnosis of livedoid vasculopathy. The patient experienced recurrent painful violaceous plaques with ulcerations during the two years of treatment with oral pentoxifylline 400 mg three times daily. The cutaneous lesions and symptoms dramatically improved after the treatment regimen changed to oral sulodexide (250 lipasemic units) three times daily. Sulodexide, a highly purified mixture of glycosaminoglycans including dermatan sulfate and lowmolecular weight heparin, could be an effective therapy for recalcitrant livedoid vasculopathy. Herein, we report a case of livedoid vasculopathy treated with sulodexide, which has not previously been reported.

Abstract

We report a 29-year-old female with a one-month history of non-healing multiple erythematous to violaceous plaques with crusts over both legs and feet. Tender, scarring ulcers with surrounding erythema were present. The clinical manifestation, together with histopathologic findings of fibrinoid plugs within vascular lumens and walls, as well as red blood cell extravasation, led to diagnosis of livedoid vasculopathy. The patient experienced recurrent painful violaceous plaques with ulcerations during the two years of treatment with oral pentoxifylline 400 mg three times daily. The cutaneous lesions and symptoms dramatically improved after the treatment regimen changed to oral sulodexide (250 lipasemic units) three times daily. Sulodexide, a highly purified mixture of glycosaminoglycans including dermatan sulfate and lowmolecular weight heparin, could be an effective therapy for recalcitrant livedoid vasculopathy. Herein, we report a case of livedoid vasculopathy treated with sulodexide, which has not previously been reported.

참고문헌 (8)

  1. Kang S, "Fitzpatrick's dermatology", pp.2532~2533 (2019), McGraw-Hill Education
  2. Weishaupt C, "Characteristics, risk factors and treatment reality in livedoid vasculopathy- a multicentre analysis", J Eur Acad Dermatol Venereol, 33, pp.1784~1791 (2019)
  3. Micieli R, "Treatment for livedoid vasculopathy : a systematic review", JAMA Dermatol, 154, pp.193~202 (2018)
  4. Dou H, "Heparinoids Danaparoid and Sulodexide as clinically used drugs", Prog Mol Biol Transl Sci, 163, pp.55~74 (2019)
  5. Sopeña B, "Livedoid vasculopathy and recurrent thrombosis in a patient with lupus: seronegative antiphospholipid syndrome?", Lupus, 19, pp.1340~1343 (2010)
  6. 소병준, "Successful Treatment of Livedoid Vasculitis with Primary Antiphospholipid Syndrome by Using Aspirin and Low Dose Warfarin Combination Therapy", Annals of Dermatology, 27(5), pp.614~615 (2015), 대한피부과학회
  7. Franco Marques G, "The management of livedoid vasculopathy focused on direct oral anticoagulants(DOACs) : four case reports successfully treated with rivaroxaban", Int J Dermatol, 57, pp.732~741 (2018)
  8. Coccheri S, "Development and use of sulodexide in vascular diseases : implications for treatment", Drug Des Devel Ther, 8, pp.49~65 (2013)

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