Treatment of Livedoid Vasculopathy with Short-cycle Intravenous Immunoglobulins

Abstract

Sir, Livedoid vasculopathy manifests in the form of painful, recurrent ulcers on the lower limbs. The condition is mainly found in young and middle-aged women (1). Histologically, the disorder is characterized by the presence of hyaline thrombi in the cutaneous microcirculation. The underlying pathogenesis is not known, although local or systemic alterations in coagulation control appear to be involved, leading to fibrin thrombus formation in the blood vessels of the superficial dermis. Although sometimes considered synonymous, it is advisable to avoid the terms livedoid vasculitis and segmental hyalinizing vasculitis, as there is no histological evidence of vasculitis (2). The term atrophie blanche should also be avoided, as it is merely descriptive – referring to the formation of whitish scars with telangiectatic margins, although without considering the aetiology or physiology of the lesions. The term livedoid vasculopathy should be reserved for the primary idiopathic presentations of the disease. No controlled comparative studies have been made of the different treatment modalities used. We report here a case of livedoid vasculopathy treated with intravenous immunoglobulins (IVIg).