warfarin and Skin-Diseases--Vascular

A 64-year-old woman presented with a hemorrhagic perifollicular rash on her legs while taking warfarin. After biopsy, vitamin C deficiency was suggested as the diagnosis, which ascorbic acid assays later confirmed. Clinical resolution of the rash followed supplementation with vitamin C. Patients on a vitamin K limited diet may also be limiting their intake of vitamin C. Physicians should be aware of this possible correlation, and consider checking vitamin C levels in patients with a perifollicular hemorrhagic rash or other signs of vitamin C deficiency while on warfarin.

Topics: Anticoagulants; Ascorbic Acid; Ascorbic Acid Deficiency; Drug Eruptions; Female; Humans; Leg Dermatoses; Middle Aged; Skin Diseases, Vascular; Warfarin

Topics: Aged; Anticoagulants; Autoantibodies; Chronic Disease; Female; Humans; Leg Dermatoses; Phosphatidylserines; Prothrombin; Skin Diseases, Vascular; Warfarin

Livedoid vasculopathy (LV) is a chronic idiopathic disease characterized by painful purpuric macules on lower extremities. Its exact aetiology remains uncertain, but thrombotic and microcirculatory phenomena have been implicated as possible pathogenic factors.. To assess prospectively the frequency of thrombophilia and to verify the effectiveness of anticoagulant therapy among LV patients.. Thirty-four LV patients were tested for prothrombin time, activated partial thromboplastin time, antithrombin activity, protein C and S activity, anticardiolipin antibodies, lupus anticoagulant, prothrombin gene mutation, factor V Leiden mutation, methylenetetrahydrofolate reductase mutation, plasma homocysteine and fibrinogen. Thirteen of these patients were treated with anticoagulant drugs (either warfarin or heparin).. Of 34 patients, 18 (52%) presented laboratory abnormalities of procoagulant conditions. Positive treatment response to anticoagulant therapy was observed in 11 patients. Improvement of pain was obtained in 1-3 weeks, an average of 1.8 week. Complete healing of the lesions was observed in about 2.3 months. Remission was sustained even after treatment interruption and lasted an average 7.8 months. No severe adverse effects were noticed.. The authors suggest all patients with diagnosis of LV to be investigated for thrombophilic status. Anticoagulant drugs were well tolerated and seemed to be effective in treating not only LV symptoms but also its ulcerations.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Anticardiolipin; Anticoagulants; Blood Coagulation Tests; Factor V; Female; Fibrinogen; Heparin; Homocysteine; Humans; Lupus Coagulation Inhibitor; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Prospective Studies; Protein C; Protein S; Prothrombin; Skin Diseases, Vascular; Thrombophilia; Warfarin; Young Adult

Topics: Anticoagulants; Female; Humans; Male; Middle Aged; Protein C; Protein C Deficiency; Protein S; Protein S Deficiency; Skin; Skin Diseases; Skin Diseases, Vascular; Warfarin

A 50-year-old woman had a lifelong history of painful ulcerations as a result of livedoid vasculopathy. She was a heterozygous carrier of factor V Leiden and prothrombin gene mutations and was receiving hormone replacement therapy. The ulcers healed after warfarin therapy, which has been reported to be effective in only one previous patient with this condition.

Topics: Anticoagulants; Factor V; Female; Heterozygote; Humans; Leg Ulcer; Livedo Reticularis; Middle Aged; Mutation; Prothrombin; Skin Diseases, Vascular; Thrombophilia; Warfarin

Livedoid vasculopathy is characterized by painful purpuric lesions on the extremities which frequently ulcerate and heal with atrophic scarring. It has been considered to be a vasculitic process but now there has been increasing evidence that abnormal coagulation plays a major role in the pathogenesis of this rare disorder. We report the case of a 19-year-old male who had been suffering from recurrent painful ulcerations on both lower legs with atrophic scars for 4 years. A biopsy specimen revealed vasculopathy, and laboratory studies showed resistance to activated protein C with factor V Leiden mutation. Treatment with oral warfarin led to rapid improvement of the lesions.

Topics: Administration, Oral; Adult; Anticoagulants; Factor V; Humans; Leg Ulcer; Male; Mutation; Skin Diseases, Vascular; Warfarin

A 53-year-old woman presented with a chronic history of recurrent, painful ulcers, predominantly involving her lower legs. Both her clinical picture and histopathological findings were consistent with a diagnosis of livedoid vasculopathy, although she did have unusual findings of deep tender nodules and the presence of lesions over her elbows. Multiple investigations were undertaken, the only abnormality being a heterozygous mutation of the prothrombin G2021A gene. Although various coagulopathic states have been associated with livedoid vasculopathy, the finding of an associated prothrombin gene mutation is quite rare. Warfarin has ameliorated the clinical course when anti-inflammatory drugs and other anticoagulants were unhelpful.

Topics: Anticoagulants; Female; Heterozygote; Humans; Leg Ulcer; Middle Aged; Point Mutation; Prothrombin; Skin Diseases, Vascular; Warfarin

Livedoid vasculopathy is an idiopathic, chronic disorder manifested by painful, purpuric macules on the lower extremities that superficially ulcerate, resulting in atrophic, stellate scars with peripheral telangiectasias and hyperpigmentation.. A 50-year-old man presented with recurrent, painful ulcerations on the medial aspect of his malleoli and calves. The clinical presentation, histologic findings, and results of laboratory evaluation confirmed the diagnosis of livedoid vasculopathy in this case. Despite being refractory to treatment with multiple other medications, the lesions responded dramatically to oral warfarin sodium therapy.. Treatment with warfarin may be a beneficial therapy for patients with livedoid vasculopathy.

Topics: Anticoagulants; Biopsy; Cryoglobulinemia; Cryoglobulins; Diagnosis, Differential; Fibrinogens, Abnormal; Follow-Up Studies; Humans; Hyperhomocysteinemia; Male; Middle Aged; Skin; Skin Diseases, Vascular; Warfarin

Antiphospholipid syndrome (APS) has been well defined in adults; however, primary nontraumatic arterial thrombosis owing to this entity is unusual in the pediatric population. The authors report a case of APS with lower extremity arterial thrombosis who had discolored feet since delivery.

Topics: Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Aspirin; Child, Preschool; Collateral Circulation; Heparin, Low-Molecular-Weight; Humans; Immunoglobulin G; Immunosuppressive Agents; Intermittent Claudication; Leg Ulcer; Male; Prednisolone; Skin Diseases, Vascular; Thrombophilia; Warfarin