Recurrent leg ulcers due to livedoid vasculopathy: successful treatment with low-molecular-weight heparin

History and admission findings: A 50-year-old women had suffered from recurrent and extremely painful ulcerations of both legs and the back of her feet for about 3 weeks. The clinical examination showed multiple hemorrhagic and bizarre configured ulcerations with a surrounding livid-erythematous discoloration, hyperpigmentation and extensive atrophie blanche. Investigations: Neither instrument-based nor serological tests revealed specific pathological findings. Histological results from the border area of the ulceration confirmed the diagnosis of livedoid vasculopathy. Treatment and course: A systemic treatment with low-molecular- weight heparin was initiated, resulting in a rapid pain reduction and complete healing of the ulcerations after some weeks of therapy. Conclusion: This case report demonstrates that unusual entities like livedoid vasculopathy should be considered as rare causes for recurrent leg ulcers because different underlying etiologies need different specific treatment strategies. Until now treatment for patients with livedoid vasculopathy has not been standardized but anticoagulative therapy with low-molecular-weight heparin is considered to be one treatment of first choice.