A Clinical and Histopathological study of Livedo Vasculitis

Lee, Chang Kyun; Seo, Seong Jun; Kim, Myeung Nam; Hong, Chang Kwun; Ro, Byung In

Abstract

BACKGROUND: Livedo vasculitis predominantly affects middle-aged females with relapses in summer, and fluctuating in winter. It develops spontaneously or in association with connective tissue disorders. Histopathologically, the common feature is partial or complete obstruction of vessels with deposits of fibrinoid material in the upper and mid-derrnal vessel walls. Many studies of large series have been reported in the west, but few collective studies of livedo vasculitis have been reported in Korea.
OBJECTIVE
The purpose of this study was to clarify the clinical and histopathologic features of the livedo vasculitis in Korea.
METHODS
19 patients with livedo vasculitis who had visited the Department of Dermatolagy, Chung-Ang University Hospital during the last 9 years(19861 - 1994.12) were evaluated.
RESULTS
1. The age distribution was in the range of 5-73 years. The prevalence was highest in the third decade. Sex ratio was 1.7: 1.0(12 males : 7 females). 2. All patients had purpuric or telangiectatic lesions on the lower extremities. Painful ulcers developed in 11 patients(78.9%), livedo reticularis in 8(42.1%), and healed leaving whithish atrophic scars in 4 patients(21.1%). 3. In 9 patients(47.4%) the skin lesions developed or aggravated in summer, 6 patients(31.6% ) in winter, 3 patients(15.8%) in spring, and 1 patient(5.3%) in autumn. 4. Leukocytosis was observed in 3 of 17 patients, and VDRL test was positive in 2 of 12 patients. ANA test was positive(1: 40, speckled pattern) in 3 of 7 patients. 5. Histopathologically, partial to complete obstruction of dermal blood vessels with fibrinoid thrombi, endothelial swelling, and extravasation of RBCs were observed in upper and mid-dermis. 6. 16 patients were treated with aspirin, dipyridamole, pentoxifylline and corticosteroid and among them, 10(62.5%) patients were improved slowly, but, 6(37.5%) patients turned out no response or even aggravation.
CONCLUSION
According to this study, seasonal variation of livedo vasculitis showed a tendency tn aggravate in summer and winter. We found that livedo reticularis, which showed slow reduction of blood flow in the subpaillary venous plexus were often followed by livedo vasculitis.