RESUMO
BACKGROUND: Coagulation disorders contribute to the development of livedoid vasculopathy (LV). Elevated plasma levels of lipoprotein(a) [Lp(a)] are an independent risk factor for the development of cardiovascular disease and associated with hypercoagulable states. Increased serum Lp(a) levels have been reported in patients with LV and may have an important role in the pathogenesis of LV. OBJECTIVES: To investigate Lp(a) expression in skin lesions and circulating serum Lp(a) levels in patients with LV. METHODS: Skin biopsy samples from 38 patients (27 women and 11 men) with active lesions diagnosed as LV and 9 samples of normal skin (5 women and 4 men) from control patients without LV were evaluated for skin expression of Lp(a) by immunohistochemistry. Plasma levels of Lp(a) were analyzed by immunoturbidimetry. RESULTS: We found that lesional skin in patients with LV expressed 10-fold higher Lp(a) immunostaining than controls. High plasma levels of Lp(a) were observed in LV patients. We did not find a correlation (P = .02) between expression of Lp(a) in the skin and plasma levels of Lp(a) in patients with LV. CONCLUSIONS: Increased Lp(a) expression in lesional skin of LV patients suggests the role of Lp(a) in the thrombo-occlusive vasculopathy observed in this disease.
Assuntos
Úlcera da Perna/patologia , Lipoproteína(a)/sangue , Livedo Reticular/sangue , Dermatopatias/patologia , Pele/metabolismo , Trombofilia/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Úlcera da Perna/complicações , Lipoproteína(a)/metabolismo , Livedo Reticular/complicações , Livedo Reticular/metabolismo , Livedo Reticular/patologia , Masculino , Pessoa de Meia-Idade , Pele/patologia , Dermatopatias/metabolismo , Trombofilia/metabolismo , Doenças Vasculares , Adulto JovemRESUMO
Chronic venous disease affects millions of people around the world. Venous valvular incompetencies and venous reflux, often a result of outflow obstruction are important contributors to venous disease. The prevalence of thrombophilia is increased in patients with chronic venous insufficiency (CVI). The recognition of underlying thrombophilia particularly in young patients opens new avenues in the management and prevention plan. We emphasize on the consideration of workup for coagulopathy, especially factor VIII deficiency in young patients with venous disease. We report 3 patients with chronic leg ulcers and high levels of FVIII:C activity in plasma and other associated thrombophilic factors. We highlight the need to get a workup done for thrombophilia in young patients with recurrent and chronic leg ulcers related to venous insufficiency or livedoid vasculopathy. Further studies with larger sample sizes are required to define the definite indications for the thrombophilia workups.
RESUMO
Livedoid vasculopathy is a bilateral painful and recurrent cutaneous ulcerative disorder of the legs that leads to atrophie blanche, atrophic white-porcelain scars, and is associated with disorders of fibrinolysis and/or coagulation. We present a young boy with an association between livedoid vasculopathy in the area of a previous involuted cutaneous hemangioma. We found 4 uncommon abnormalities associated with thrombo-occlusive events: heterozygous 20210 AâG genotype of prothrombin, reduced activity of anticoagulation proteins C and S, and elevated lipoprotein (a).
Assuntos
Aspirina/administração & dosagem , Transtornos da Coagulação Sanguínea/complicações , Hemangioma/complicações , Úlcera da Perna , Livedo Reticular , Pentoxifilina/administração & dosagem , Neoplasias Cutâneas/complicações , Adolescente , Biópsia , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/fisiopatologia , Testes de Coagulação Sanguínea , Diagnóstico Diferencial , Hemangioma/diagnóstico , Hemangioma/fisiopatologia , Técnicas Histológicas/métodos , Humanos , Úlcera da Perna/etiologia , Úlcera da Perna/patologia , Úlcera da Perna/fisiopatologia , Livedo Reticular/diagnóstico , Livedo Reticular/tratamento farmacológico , Livedo Reticular/etiologia , Livedo Reticular/fisiopatologia , Masculino , Inibidores da Agregação Plaquetária/administração & dosagem , Protrombina/genética , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/fisiopatologia , Resultado do Tratamento , Ultrassonografia Doppler/métodosRESUMO
Venous ulcers are the most common form of leg ulcers. Venous disease has a significant impact on quality of life and work productivity. In addition, the costs associated with the long-term care of these chronic wounds are substantial. Although the exact pathogenic steps leading from venous hypertension to venous ulceration remain unclear, several hypotheses have been developed to explain the development of venous ulceration. A better understanding of the current pathophysiology of venous ulceration has led to the development of new approaches in its management. New types of wound dressings, topical and systemic therapeutic agents, surgical modalities, bioengineered tissue, matrix materials, and growth factors are all novel therapeutic options that may be used in addition to the "gold standard," compression therapy, for venous ulcers. This review discusses current aspects of the epidemiology, pathophysiology, clinical presentation, diagnostic assessment, and current therapeutic options for chronic venous insufficiency and venous ulceration. (J Am Acad Dermatol 2001;44:401-21.) Learning objective: At the conclusion of this learning activity, participants should be familiar with the 3 main types of lower extremity ulcers and should improve their understanding of the epidemiology, pathogenesis, risk factors, clinical presentation, diagnostic assessment, and current therapies for chronic venous insufficiency and venous ulcers.