Bei der Livedovaskulopathie kommt es durch eine Gefäßokklusion zur Ischämie mit anschließender
Ulzeration der Haut. Die Erkrankung hat chronisch rezidivierende Verläufe und tritt
ausschließlich an der unteren Extremität auf. Dieser Artikel beschreibt die klinischen
Besonderheiten und die Therapieoptionen der Livedovaskulopathie. Die Empfehlungen
stehen im Einklang mit der aktuellen S1-Leitlinie „Diagnostik und Therapie der Livedovaskulopathie“.
Abstract
Livedovasculopathy is a chronic and recurrent disease in which an insufficient perfusion
of the skin leads to ischemia and subsequent ulceration. Painful, recurrent ulcerations
on the lower legs are characteristic. A clinical triad consisting of livedo racemosa,
ulceration and atrophie blanche is typical. The disease manifests itself exclusively
in the lower extremity and especially in the malleolar region. Typically, the patients
describe burning pain, which is limited to the place of manifestation does not show
any seasonal accumulation. The diagnosis of LV is based on the clinical image and
histology. The histological confirmation should be carried out in the acute stage
of ischemia. The typical fibrin thrombi can be detected with a spindle biopsy from
the peripheral area of the manifestation.
First-line therapy consists of low molecular weight heparin, direct oral anticoagulants,
or intravenous immunoglobulins. The rapid diagnosis and initiation of therapy to avoid
irreversible ulcerations is crucial for the long-term management.
Schlüsselwörter
Livedo racemosa - Ulzeration - Atrophie blanche - Thrombus
Keywords
livedo racemosa - ulceration - atrophie blanche - thrombus
