Pentoxifilina: ¿qué quedó de la droga de la década?: what has remained of the drug of the decade? / Pentoxifillyne

Una revisión sobre los efectos y utilidades de la pentoxifilina, desde los años noventa y la efectividad demostrada en la experiencia del autor, es comunicada. Se remarca su efectividad en la necrobiosis lipoídica, livedo vasculitis, así como la posibilidad de volver a ensayarla en otras entidades, donde la hipercoagulabilidad-hiperviscosidad sanguínea, esté involucrada en la etiopatogenia de las mismas.

Since the early 90s it has been reviewing the potential therapeutic utilities of pentoxifillyne. The usefulness of the drug in the treatment of necrobiosis lipoídica and livedo vasculitis is reinforced. In addition I suggest training again the pentoxifillyne in conditions where the hypercoagulable and hyperviscosity of the blood are involved.

Clinical analysis of 47 cases of livedo vasculitis / 中华皮肤科杂志

Objective To assess the clinical and pathological feature of patients with livedo vasculitis.Methods Clinical data were collected from 47 patients with livedo vasculitis,and retrospectively analyzed.All the patients were classified into three groups according to treatment strategy:anticoagulation group,anticoagulation + corticosteroids group,and anticoagulation + sulfasalazine group.Results Clinically,livedo vasculitis usually began as petechia or ecchymosis,edema with distending pain,followed by spotty necrosis which subsequently evolved into vermiculated ulcers and,finally,atrophie blanche.Pathological features included fibrinoid degeneration of and thrombus formation in small vessel walls within the superficial or deep dermis,as well as a sparse lymphocytic infiltrate around the injured vessels.The average time to onset of action of administrated drugs was (9.14 ± 3.48),(5.62 ± 1.04) and (8.23 ± 2.68) days,and time to remission was (2.57 ± 1.41),(4.06 ± 1.51) and (5.64 ± 1.32) months,in the anticoagulation group,anticoagulation + corticosteroids group and anticoagulation + sulfasalazine group,respectively.Conclusion Anticoagulation in combination with anti-inflammatory therapy appears to have a more rapid onset of action in the treatment of livedo vasculitis with a reduced recurrence rate compared with anticoagulation therapy alone.

Kampo Treatment for Painful Multiple Ulcers of the Lower Limb Associated with Livedo Vasculitis : A Case Report / 日本東洋医学雑誌

Livedo vasculitis is one of the most difficult dermatological diseases to cope with in routine clinical practice. We report the case of a 23-year-old woman, who was diagnosed with livedo vasculitis and was responsive to Kampo treatment. She had a rash-like bruise from the spring of X-2, being diagnosed with livedo vasculitis at another hospital. In April, X, painful multiple ulcers on both lower limbs were beginning to appear and were resistant to the western standard therapy. In May 6,X, we started Kampo therapy for her at our hospital. After 4 months, her painful ulcers disappeared. We used tokishigyakukagoshuyushokyoto as the main agent, along with kakobushimatsu, hainoto, senkinnaitakusan, hakushusan and tokishakuyakusan. Although her livedo symptoms still remain and may need long-term treatment to heal completely, she obtained relief from painful ulcers, returning to her normal daily life.

Pulsed Intravenous Immunoglobulin Therapy in Livedo Vasculitis: Report of Two Cases / 대한피부과학회지

Livedo vasculitis is a chronic dermatosis characterized by recurrent painful ulceration of the lower limbs, which heals to leave atrophie blanche. The precise pathophysiology is not known. Antiplatelet, anticoagulant, fibrinolytic therapies and anabolic steroids have been reported to be helpful in this syndrome. However, no consistent benefit has been demonstrated with any treatment modality. Recently, pulsed intravenous immunoglobulin therapy has been reported to be effective in some refractory cases. We herein report two cases of recalcitrant livedo vasculitis which were effectively treated with pulsed intravenous immunoglobulin therapy. These were the first trials carried out in Korea.

A Surgical Experience of Livedo Vasculitis: A Case Report

PURPOSE: Livedo vasculitis is recurrent painful ulceration of the feet, ankles and legs characterized by purpuric papules and plaques that undergo superficial necrosis and healing with residual white atrophic scars (atrophie blanche). The typical histopathologic findings of livedo vasculitis are characterized by endothelial proliferation and hyaline degeneration along with thrombosis of dermal vessels. Standard therapeutic strategies for treatment of livedo vasculitis are usually on the basis of rheologic, anti-inflammatory or immnosuppressive treatments, a aspirin, dipyridamole, glucocorticosteroids, pentoxyfylline, or high-dose intravenous immunoglobulin are often ineffective or partially effective. METHODS: We report a case of 24-year-old male patient with livedo vasculitis on the ankles and dorsal surfaces of both feet. RESULTS: The lesion that had been unresponsive to medical treatment were successfully healed with complete debridement and skin grafting without recurrences. CONCLUSION: Surgical treatment can be one of the therapeutic choice in Livedo vasculitis.

Treatment with Low-Dose Danazol in Livedo Vasculitis / 대한피부과학회지

BACKGROUND: Several modalities have been used for the treatment of livedo vasculitis. However, in some cases conspicious morbidity is caused by recurrent painful ulceration resistant to therapy. OBJECTIVE: This study was conducted to determine the effectiveness and adverse effects of the danazol in treatment of livedo vasculitis. METHODS: Nine patients with ulcerative lesions due to livedo vasculitis were included for danazol therapy. Danazol 200mg was administered daily for 4 to 8 weeks. RESULTS: Eight of the patients showed remarkable improvement and were satisfied with this therapy. Significant adverse effects were not observed. CONCLUSION: We suggest that a low dose of danazol may be considered as the first line of treatment and is worthwhile to try in cases recalcitrant to the other treatment.

A Clinical and Histopathologic Study of Livedo Vasculitis / 대한피부과학회지

BACKGROUND: Livedo vasculitis shows variable clinical and histopathologic features according to its courses. There are also some discrepancies in histopathologic findings between the authors. OBJECTIVE: Our purpose is to clarify the clinical and istopathologic feat tures of livedo vasculitis. METHODS: We reviewed the clinical and histopathologic features in cluding direct immunofluorescence study and response to treigtment in eight patients with livedo vasalitis. RESULTS: The ratio of males to females was 1:3 with female predusm nance. Age of onset was predominant, in young to middle-age, ranging from 19 to 64 years old. In seven patients skin lesions were aggravated during the summe, and in one patient during the winer. All patients had purpuric or telangiectatic lesions on the lower extremities. Painful ulcers developed in seven patients and some of the ulcers healed with whitish atrophic scars. Five patients had preceeding livedo reticularis. One patient had Raynauds phenomenoin and the other patients did not show alinormal findings related to the systemic diseases. Histopathologically, in two patients fibrinoid materi.il was deposited in the vessel walls mildly, and in six patients obviously with partial to complete obst,r iction of blood vessels. Extravasation of RBCs and thrombus formation were found clearly in seven patients, but in one patient these findings were observed in a mild degree. Endothelial swellings were obserrved in all patients. Perivascular infiltrations of mononuclear cells were also observed in all patients in various degrees. But only two patients with secondary bacterial infection showed neutrophil infilt ations or nuclear dusts. So, histopathologic findings are corripatible with lymphocytic vasculitis. The locations of predominantly affected vessels were variable. Direct immunofluorescence studies were done in six patients. Four of these patients showed positive findings. At least 4 months were needed for the complete healing of the skin lesions. CONCLUSION: Livedo vasculitis is chronic vasculit is aggravated in mostly summer. Most of the initial purpuric lesions progress to ulcers which is healed with whitish atrophic scars. Histopathoiogic findings suggest livedo vasculitis is a sort of lymphocytic vasculitis.

Three Casesof Livedo Vasculitis Cleared by Combined Therapy of Acetylsalicylic Acid , Dipyridamole and Nifedipine / 대한피부과학회지

Livedo vasculitis clinically shows purpuric papules and recurrent ulcers in the lower extremities, mainly on the ankles, leaving characteristic scars called atrophie blanche after the healing of the ulcers. Its characteristic histopathologic features and clinical evolution indicate that the common pathologic event is occlusion of vessels in the middle and deep dermis. In Korean literature, seven cases of this disease have been reported but the response of the treatment was not, satisfactory. We report three cases of livedo vasculitis cleared by combined ther by of acetylsalicylic acid, dipyridamole and nifedipine, which has not been reported in Korean literatur.