Analysis of serum levels and cutaneous expression of lipoprotein (a) in 38 patients with livedoid vasculopathy

Espinel, Danielle P.G.S.; Giacomo, Thais Bello Di; Pincelli, Thais; Pereira, Newton Lindolfo; Sotto, Miriam Nacagami; Kirsner, Robert S.; Criado, Paulo Ricardo

doi:10.1111/cup.13043

Cited by 14 publications

(10 citation statements)

References 28 publications

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“…Both facts are similar to data published by Renner et al . while others had described a female‐to‐male ratio of 3 : 1 and a clearly younger population with a mean age of 32 or 37 years . The average BMI in our study population was only slightly lower (25.6 kg/m²) compared to an age‐matched German population with a BMI of 26.4 kg/m² although BMI was elevated in 40% of LV patients.…”

Section: Discussionsupporting

confidence: 91%

“…Both facts are similar to data published by Renner et al 15 while others had described a female-to-male ratio of 3 : 1 16,17 and a clearly younger population with a mean age of 32 or 37 years. 18,19 The average BMI in our study population was only slightly lower (25.6 kg/m²) compared to an age-matched German population with a BMI of 26.4 kg/m² 20 although BMI was elevated in 40% of LV patients. In addition, the rate of hypertension (70%) was clearly higher in LV patients compared to the prevalence of hypertension in females (44%) or males (51%) in Germany at the same age.…”

Section: Discussionmentioning

confidence: 52%

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Characteristics, risk factors and treatment reality in livedoid vasculopathy – a multicentre analysis

Weishaupt

Strölin

Kahle³

et al. 2019

Acad Dermatol Venereol

105

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Background Livedoid vasculopathy (LV) is a rare cutaneous thrombotic disease. It is characterized by occlusion of dermal vessels resulting in livedo racemosa, ulceration and atrophie blanche. Clear guidelines for diagnosis and treatment are missing. Objective The purpose of this study was to better characterize epidemiology, clinical appearance and treatment reality of LV in a well‐defined patient cohort. Methods The cohort was allocated within a prospective, multicentre, phase IIa trial that investigated the effect of rivaroxaban in LV. Results Analysis of 27 patients revealed that LV patients had an increased Body Mass Index (BMI; 11/27), hypertension (19/27) and increased levels of lipoprotein (a) (5/12) and homocysteine (10/12) in the blood. The female‐to‐male ratio was 2.1 : 1, and the median age was 53.0 years [interquartile range (IQR) 40.5–68]. Investigation of the clinical appearance found that 82% of patients had livedo racemosa, and the ankle region was most likely to be affected by ulceration (56–70%). The analysis of patient treatment history showed that heparin was most effective (12/17), while anti‐inflammatory regimens were, although often used (17/24), not effective (0/17). Conclusion We add clinical clues for a data supported diagnosis of LV, and we provide evidence that anticoagulants should be administered in monotherapy first line (EudraCT number 2012‐000108‐13‐DE).

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 52%

Characteristics, risk factors and treatment reality in livedoid vasculopathy – a multicentre analysis

Weishaupt

Strölin

Kahle³

et al. 2019

Acad Dermatol Venereol

105

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“…Lipoprotein A (LpA) plays a major role in thrombo-occlusive vasculopathy. 58,59 Criado et al demonstrated thrombosis, fibrin, and LpA deposition on cutaneous blood vessels in a patient with livedoid vasculopathy. Convincing data has shown genetic variability in LpA levels between ethnic populations.…”

Section: Capsule Summary Dmentioning

confidence: 99%

Skin manifestations of COVID-19: A worldwide review

Tan¹,

Tam²,

Oh³

2021

JAAD International

122

144

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Introduction Because of the increasing emergence of skin manifestations of the coronavirus disease 2019 (COVID-19) worldwide, we investigated the published reports of these lesions. Methods We conducted a literature search for original and review articles published from November 11, 2019, to September 30, 2020. Results We determined five skin lesions common in patients with COVID-19: pseudo-chilblains, maculopapular, urticarial, vesicular, and vaso-occlusive lesions. These lesions manifest at various times in relation to COVID-19 symptoms, which may indicate whether the lesions are virus-induced or are delayed immunological responses to the infection. Skin lesions are more prevalent among Europeans and US residents than among Asians, as is pseudo-chilblain, and the morphology of the skin lesions varies between continents. Pseudo-chilblains are the most common COVID-19 skin manifestation in Europe and the United States, but there is only one reported case from Asian populations. Additionally, patients with vaso-occlusive lesions are more likely than those with pseudo-chilblains to be admitted to the intensive care unit and to die. Conclusion Different cutaneous manifestations in patients with COVID-19 could reflect a wide spectrum of viral interactions with the skin, though reporting bias may play a role as well.

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“…Alterations in plasma lipoprotein(a) level have been associated with the pathogenesis of vasculopathies such as livedoid vasculopathy and vasculitis associated with Behcet's disease. [23][24][25] Studies with a larger number of patients are required to establish whether lipoprotein(a) has a thrombotic role in the pathogenesis of CPAN.…”

Section: Discussionmentioning

confidence: 99%

M2 macrophage polarization in cutaneous polyarteritis nodosa: an immunohistochemical study

Marques

Criado

Pagliari

et al. 2020

Preprint

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Background Cutaneous polyarteritis nodosa (CPAN), a cutaneous vasculitis that affects small-and medium-sized arteries, is thought to be mediated by immune complexes. However, little is known about its etiology. Macrophages are important pathogenic factors in various vascular inflammatory diseases, including certain types of vasculitis. However, their role in CPAN remains unexplored. Objectives To describe the demographic, clinical, and laboratory findings and investigate the distribution of M1 and M2 macrophages in CPAN. Methods This was a cross-sectional study involving fourteen patients with CPAN and nine control participants. Medical records were reviewed to determine demographic and clinical data, and laboratory findings. Skin biopsies obtained during disease manifestations were evaluated immunohistochemically. M1 macrophages were identified using STAT1 expression, and M2 macrophages were identified using CD163, CD206, and CMAF expression. Results CPAN was predominant in women, and the mean age of patients was 39 years. The main dermatological lesions were ulcers, subcutaneous nodules, and livedo. Increased lipoprotein(a) levels (28%) and a positive tuberculin skin test in 40% of the tested patients were our main laboratory findings. Direct immunofluorescence was positive in 88.9% of the cases. Immunohistochemical analysis revealed an increased percentage of M2 macrophages in CPAN patients compared with that in the control group. Conclusions This is a novel study on macrophage polarization in CPAN, where the number of cells expressing CD163 and CMAF was found to be increased. M2 macrophage predominance suggests an important role for the innate immune system in the pathophysiology of CPAN and may provide insights for potential therapeutic targets.

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Analysis of serum levels and cutaneous expression of lipoprotein (a) in 38 patients with livedoid vasculopathy

Abstract: Increased Lp(a) expression in lesional skin of LV patients suggests the role of Lp(a) in the thrombo-occlusive vasculopathy observed in this disease.

Cited by 14 publications

References 28 publications

Characteristics, risk factors and treatment reality in livedoid vasculopathy – a multicentre analysis

Characteristics, risk factors and treatment reality in livedoid vasculopathy – a multicentre analysis

Skin manifestations of COVID-19: A worldwide review

M2 macrophage polarization in cutaneous polyarteritis nodosa: an immunohistochemical study

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