A Case of Livedoid Vasculopathy Successfully Treated with Sulodexide

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 low-molecular 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.

Pain Management Options in a Patient with Livedoid Vasculopathy and Peripheral Neuropathy

“…Therapies targeting PAI-1 can pave the way for further studies in treating refractory LV [ 13 ] . Song et al have published a case report on sulodexide, which is a highly purified mixture of glycosaminoglycan including dermatan sulfate and low-molecular-weight heparin proven to be effective in the treatment of LV [ 14 ] . Intermittent low-dose dabigatran has also been proven to be effective in the maintenance of remission in LV [ 15 ] .…”