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Livedoid Vasculopathy Medication

  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: William D James, MD  more...
 
Updated: Jan 25, 2016
 

Medication Summary

Drugs stimulating endogenous fibrinolytic activity and drugs inhibiting thrombus formation (antiplatelet and anticoagulant) are possible treatments of livedoid vasculopathy.

Severe livedoid vasculopathy related to antibodies involving the antiphosphatidylserine-prothrombin complex has been successfully treated with warfarin.[48]

Treatment of livedoid vasculopathy using alprostadil (PGE-1) seems like a possible treatment option for livedoid vasculopathy.[49]

Low molecular weight heparin has been used to treat livedoid vasculopathy in a patient with a positive test for lupus anticoagulant and the presence of the MTHFR mutation.[50]

A new drug, rivaroxaban, which has undergone phase II trials for livedoid vasculopathy, is undergoing development. Rivaroxaban exerts effects on the coagulation cascade. Rivaroxaban inhibits the factor Xa–dependent transformation of prothrombin to thrombin. Thus, rivaroxaban substantially reduces the risk of thrombosis.[51, 52]

Intravenous immunoglobulin (IVIG) holds promise of treating livedoid vasculopathy and was effective at 2 g/kg of IVIG every 4 weeks in a trial of 11 patients in ameliorating livedoid vasculopathy, with long-term follow up.[53] Improvement occurred in 59% of patients after 3 cycles and 86% after 6 cycles. After 7 and 8 cycles in previous treatment failure, a 93% success rate was achieved. After two IVIG cycles, subscore analysis demonstrated resolution of pain in 80% of patients. Quality of life and disease severity and were very much improved after 6 cycles. The median duration of remissions appeared to be 26.7 months after the initial treatment and 7.5 months in subsequent disease episodes.[53]

Treatment of sensory ganglionopathy with livedoid vasculopathy controlled by immunotherapy failed treatment with prednisolone and mycophenolate mofetil but succeeded when rituximab was added, in terms of nerve conduction stabilization and symptoms.[54]

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Cardiovascular agents

Class Summary

These agents are the drugs of choice. They may be useful in reducing pain and ulceration.

Pentoxifylline (Trental)

 

Pentoxifylline may alter the rheology of red blood cells, which, in turn, reduces blood viscosity.

Dipyridamole (Persantine, Aggrenox)

 

Dipyridamole is a platelet adhesion inhibitor that possibly inhibits red blood cell uptake of adenosine, which is an inhibitor of platelet reactivity. In addition, it may inhibit phosphodiesterase activity, leading to increased cyclic-3',5'-adenosine monophosphate within platelets and formation of the potent platelet activator thromboxane A2. Dipyridamole is a vasodilator. Use with aspirin.

Aspirin (Bayer, Ascriptin, Empirin)

 

Aspirin inhibits prostaglandin synthesis, preventing the formation of platelet-aggregating thromboxane A2. Use in a low dose to inhibit platelet aggregation and to improve complications of venous stases and thrombosis.

Nifedipine (Procardia)

 

Nifedipine relaxes coronary smooth muscle and produces coronary vasodilation, which, in turn, improves myocardial oxygen delivery. Nifedipine causes vasodilation.

Enoxaparin (Lovenox)

 

Enoxaparin prevents deep vein thrombosis, which may lead to pulmonary embolism in patients undergoing surgery who are at risk for thromboembolic complications. Enoxaparin enhances the inhibition of factor Xa and thrombin by increasing antithrombin III activity. In addition, it preferentially increases the inhibition of factor Xa. The average duration of treatment is 7-14 days.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, JD, MD, FAAD Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie<br/>Received income in an amount equal to or greater than $250 from: Optigenex<br/>Received salary from Optigenex for employment.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Richard H. Musgnug, MD, to the development and writing of this article.

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Preferred sites of vascular involvement by selected vasculitides.
 
 
 
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