International Journal of Research in Dermatology | January-February 2023 | Vol 9 | Issue 1 Page 36 International Journal of Research in Dermatology Hidayat A et al. Int J Res Dermatol. 2023 Jan;9(1):36-39 http://www.ijord.com Case Report Successful treatment of refractory livedoid vasculopathy in a patient with systemic lupus erythematosus Arie Hidayat 1 , Nanda Earlia* 1 , Mahda R. Liana 2 INTRODUCTION Livedoid vasculopathy (LV) also known as livedoid vasculitis is a rare and chronic thrombotic vasculopathy that typically affects the lower extremities. The term livedoid vasculopathy has been used because primary pathology is hypercoagulability. 1,2 LV is different from inflammatory vasculitis and classified as a coagulating disorder, a vasculopathy, which occurs when a thrombus forms in the arterial lumen and comprises blood flow. 2-4 livedoid vasculopathy is a rare diagnosis with an approximate incidence of 1 in 100,000 per year. It is 3 times more common in females than in males, especially in patients aged 15 to 50 years. A triad of livedoid vasculopathy is livedo reticularis, atrophie blanche and painful small punched out ulcer. 2,3 Diagnosis of LV are not well defined and the treatment are widely varied. 4 We present a case of LV with SLE in a woman that successfully treated with methylprednisolone, hydroxychloroquine and methotrexate. As a result, the purpose of this study is to report on the use of combination between ABSTRACT Livedoid vasculopathy (LV) also known as livedoid vasculitis is a rare and chronic thrombotic vasculopathy that typically affects the lower extremities. Diagnosis of LV are not well defined and the treatment are widely varied. We report a case of 30 years old female patient diagnosed with Livedoid vasculopathy and systemic lupus erythematous as underlying diseases. Patient presented with chief complain painful ulcer on her bilateral lower extremities. Hypercoagulable state was normal. Skin biopsy found that dermal vessels filled with erythrocytes extravasation and inflammation cell PMN. ANA profile was positive for RNP/Sm suggest that a systemic lupus erythematosus. Patient underwent successful treatment planning for methylprednisolone 16 mg twice daily, hydroxychloroquine 200 mg once daily and methotrexate 10 mg once a week. The ulcer completely resolved after 2 months of the treatment and had no recurrent ulcer. LV is a rare, chronic, and occlusive disease of the veins supplying the upper parts of the skin. Histopathological finding is thickening or hyaline changes in the walls of superficial dermal vessels and luminal fibrin deposition. Red cell extravasation and perivascular lymphocytic infiltrates are expected findings. SLE was underlying condition that cause endothelial injury and leads to thrombosis of the dermal vessels. no treatment guidelines are available for LV. Methylprednisolone, hydroxychloroquine and methotrexate have successful therapeutic response to a patient with ulcerative LV and SLE as underlying diseases. Keywords: Livedoid vasculopathy, SLE, Treatment DOI: https://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20223343 1 Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Dr. Zainal Abidin General Academic Hospital, Banda Aceh, Indonesia 2 Department of Dermatology, Faculty of Medicine, Universitas Syiah Kuala, Dr. Zainal Abidin General Academic Hospital, Banda Aceh, Indonesia Received: 23 September 2022 Revised: 14 October 2022 Accepted: 17 October 2022 *Correspondence: Dr. Nanda Earlia, E-mail: nandaearlia01@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.