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Vollständiger Abstract

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Livedoid vasculopathy (LV) is a chronic thrombotic microangiopathy characterized by painful ulcerations that significantly impair quality of life. Management of refractory LV remains challenging due to limited efficacy of conventional therapies. We report two female patients with chronic, painful ulcers unresponsive to multiple intravenous immunoglobulin (IVIG) cycles who achieved complete ulcer healing and rapid pain resolution following a combined regimen of CHAP therapy-comprising nifedipine, hydroxychloroquine, aspirin, and pentoxifylline-compression bandaging, and pinch grafts. Case 1 involved a 60-year-old smoker with hypothyroidism who showed complete ulcer closure within 28 days and full analgesia by day 21, maintaining remission at one-year follow-up. Case 2, a 55-year-old diabetic with rheumatoid arthritis, achieved near-complete healing within nine weeks, with rapid pain relief and no adverse events. This novel multimodal approach addresses key aspects of LV pathogenesis, including impaired vasodilation, platelet aggregation, and immune dysregulation, and is complemented by the analgesic and reparative benefits of pinch grafting. Our findings suggest that CHAP therapy combined with pinch grafts may represent a safe and effective treatment option for patients with refractory LV, meriting further evaluation in controlled studies.

Abstract: PubMed · Datensatz