Livedoid vasculopathy, also known as atrophie blanche and PURPLE (painful purpuric ulcers with reticular pattern of the lower extremities) is a rare, chronic vascular condition.
When they heal, they form painless white stellate scars typical of atrophie blanche. Surrounding erythema, telangiectasias, and sclerosis may be present; livedo reticularis may be seen as well.
The disease can be accompanied by atrophie blanche
(AB), a porcelain-white scar that may be seen at the base of a healed ulcer.
The examination of the leg should include palpation of pulses and a search for the signs of venous hypertension, including varicose veins, hemosiderin pigmentation, varicose eczema, atrophie blanche, and lipodermatosclerosis.
For management of leg ulcers, the leg should be assessed for signs of venous disease, in particular, varicose veins, venous dermatitis, hemosiderin deposition, lipodermatosclerosis and atrophie blanche.19,20 A venous duplex scan may aid assessment of the leg.
Venous-related skin changes may also develop, including hyperpigmentation in the perimalleolar region secondary to haemosiderin deposition, lipodermatosclerosis with scarring, thickening of the skin secondary to fibrosis in the dermis and subcutaneous fatty tissue, and atrophie blanche
characterised by circular whitish and atrophic skin surrounded by dilated capillaries and hyperpigmentation.
Minidose heparin therapy for vasculitis of atrophie blanche
. J Am Acad Dermatol.
Clinical findings in the study included edema (32% of limbs), hyperpigmentation (24%), lipodermatosclerosis (13%), dermatitis (7%), atrophie blanche
(4%), and lyrnphedema (1%).
Cutaneous clues suggestive of thrombosis in SLE patients include atrophie blanche, pseudo-Degos lesions, livedo racemosa, acral nonpalpable purpura or reticulate erythema, cutaneous necrosis, splinter hemorrhage, thrombophlebitis, and nailfold telangiectasias.
Atrophie blanche in a patient with SLE is also strong evidence of thrombotic vasculopathy.