A Clinical and Histopathologic Study of Livedo Vasculitis

Baek, Sung Ho; Kim, Nack In; Haw, Choong Rim

Abstract

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.