ABSTRACT
BACKGROUND: Livedoid vasculopathy (LV) is a chronic idiopathic disease characterized by painful purpuric macules on lower extremities. Its exact aetiology remains uncertain, but thrombotic and microcirculatory phenomena have been implicated as possible pathogenic factors. OBJECTIVES: To assess prospectively the frequency of thrombophilia and to verify the effectiveness of anticoagulant therapy among LV patients. METHODS: Thirty-four LV patients were tested for prothrombin time, activated partial thromboplastin time, antithrombin activity, protein C and S activity, anticardiolipin antibodies, lupus anticoagulant, prothrombin gene mutation, factor V Leiden mutation, methylenetetrahydrofolate reductase mutation, plasma homocysteine and fibrinogen. Thirteen of these patients were treated with anticoagulant drugs (either warfarin or heparin). RESULTS: Of 34 patients, 18 (52%) presented laboratory abnormalities of procoagulant conditions. Positive treatment response to anticoagulant therapy was observed in 11 patients. Improvement of pain was obtained in 1-3 weeks, an average of 1.8 week. Complete healing of the lesions was observed in about 2.3 months. Remission was sustained even after treatment interruption and lasted an average 7.8 months. No severe adverse effects were noticed. CONCLUSION: The authors suggest all patients with diagnosis of LV to be investigated for thrombophilic status. Anticoagulant drugs were well tolerated and seemed to be effective in treating not only LV symptoms but also its ulcerations.
Subject(s)
Anticoagulants/therapeutic use , Skin Diseases, Vascular , Thrombophilia , Warfarin/therapeutic use , Adult , Aged , Aged, 80 and over , Antibodies, Anticardiolipin/blood , Blood Coagulation Tests , Factor V/genetics , Female , Fibrinogen/metabolism , Heparin/therapeutic use , Homocysteine/blood , Humans , Lupus Coagulation Inhibitor/blood , Male , Methylenetetrahydrofolate Reductase (NADPH2)/genetics , Middle Aged , Prospective Studies , Protein C/metabolism , Protein S/metabolism , Prothrombin/genetics , Skin Diseases, Vascular/drug therapy , Skin Diseases, Vascular/epidemiology , Skin Diseases, Vascular/genetics , Thrombophilia/drug therapy , Thrombophilia/epidemiology , Thrombophilia/genetics , Young AdultABSTRACT
A case of hair depigmentation induced by chloroquine diphosphate subacute overdosage in an 11-year-old patient with dermatomyositis is presented. Normal coloured hair growth occurred after normalisation of chloroquine dosage. A discussion on possible pathomechanisms of this phenomenon is made based on experimental data and previously reported patients with the same condition.
