Clinical Characteristics and Disease Course of Livedoid Vasculopathy: A 10-Year Retrospective Analysis

Livedoid vasculopathy (LV) is a rare, chronic, recurrent thrombo-occlusive cutaneous disorder, which is also known as atrophie blanche (AB). Its characteristic clinical manifestations include livedo racemosa, painful ulcerations, and white atrophic scars predominantly on the lower extremities. This study aimed to investigate the clinical appearance, histological features and laboratory test results, treatment strategies, and clinical outcomes of LV to provide evidence for clinical diagnosis and management.

We conducted a retrospective analysis of clinical data from 69 LV patients diagnosed in the First Affiliated Hospital of Sun Yat-sen University between January 2014 and December 2024. Data encompassed demographic characteristics, clinical manifestations, histopathological features, laboratory investigations, treatment regimens, and follow-up results. Treatment efficacy was assessed based on ulcer healing time and patient-reported symptom improvement.

The median age was 31 years (range: 11-85 years), with females constituting 69.6% (48/69). Only 5 patients (7.3%, 5/69) received an initial diagnosis of LV. The predominant clinical presentations were recurrent painful ulcerations (89.9%, 62/69), white atrophic scars (82.6%, 57/69), purpura (84.1%, 58/69), livedo racemosa (75.4%, 52/69) and local pain (85.5%, 59/69) on the lower extremities. Treatment modalities primarily included anticoagulant therapy, antiplatelet therapy, corticosteroids, lipid-lowering therapy, immunosuppressive agents, traditional Chinese medicine and physical therapy modalities.

LV predominantly affects young and middle-aged females. Combination therapy with anticoagulant, antiplatelet and corticosteroids significantly contributes to ulcer healing and rapid pain relief. Long-term follow-up is necessary to monitor for potential progression to systemic diseases. As a single-center retrospective study, these findings warrant further validation through multicenter prospective research.