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Correspondence |

Severe Livedoid Vasculopathy Associated With Antiphosphatidylserine-Prothrombin Complex Antibody Successfully Treated With Warfarin

Shinji Noda, MD; Yoshihide Asano, MD, PhD; Masahide Yamazaki, MD, PhD; Yohei Ichimura, MD; Zenshiro Tamaki, MD, PhD; Tomonori Takekoshi, MD, PhD; Makoto Sugaya, MD, PhD; Shinichi Sato, MD, PhD
Arch Dermatol. 2011;147(5):621-623. doi:10.1001/archdermatol.2011.106.
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Livedoid vasculopathy (LV) is a chronic recurrent skin disease associated with various coagulopathies, clinically characterized by livedo reticularis, atrophie blanche, and painful ulcerations predominantly localized on the lower extremities. We herein report dramatic effects of warfarin therapy against rapidly progressive digital gangrene and foot ulcers in a patient with LV and antiphosphatidylserine-prothrombin complex antibody (aPS/PT).

Browning  CECallen  JP Warfarin therapy for livedoid vasculopathy associated with cryofibrinogenemia and hyperhomocysteinemia. Arch Dermatol 2006;142 (1) 75- 78
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.142.1.75]]
Deng  AGocke  CDHess  JHeyman  MPaltiel  MGaspari  A Livedoid vasculopathy associated with plasminogen activator inhibitor-1 promoter homozygosity (4G/4G) treated successfully with tissue plasminogen activator. Arch Dermatol 2006;142 (11) 1466- 1469
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.142.11.1466]]
Di Giacomo  TBHussein  TPSouza  DGCriado  PR Frequency of thrombophilia determinant factors in patients with livedoid vasculopathy and treatment with anticoagulant drugs—a prospective study. J Eur Acad Dermatol Venereol 2010;24 (11) 1340- 1346
PubMed Link to Article[[XSLOpenURL/10.1111/jdv.2010.24.issue-11]]
Miyakis  SLockshin  MDAtsumi  T  et al.  International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4 (2) 295- 306
PubMed Link to Article[[XSLOpenURL/10.1111/jth.2006.4.issue-2]]
Atsumi  TAmengual  OYasuda  SKoike  T Antiprothrombin antibodies—are they worth assaying? Thromb Res 2004;114 (5-6) 533- 538
PubMed Link to Article[[XSLOpenURL/10.1016/j.thromres.2004.08.024]]
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Figure 1.

Clinical photographs of the study patient. A, Gangrene of the right fourth and fifth toes and ulcerations on the right dorsal foot at the initial presentation. B, Ulcerations on the right lateral malleolus. C, Porcelain-white scarring and surrounding hyperpigmentation on the lower legs and dorsal feet. D, After 3 weeks of treatment, gangrene extends to all the right toes, and the ulcer is expanded. E, One year after the initiation of warfarin therapy, necrotic toes amputated spontaneously, and the size of the ulcer is significantly reduced. F, Ulcerations on the right lateral malleolus are healed.

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Figure 2.

Skin biopsy specimen from the ulcer edge shows acanthosis, perivascular lymphoneutrophilic infiltration, capillary proliferation in the papillary dermis, and dermal fibrosis. No occluded vessels or fibrinoid degeneration were found (hematoxylin-eosin, original magnification ×100).

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