Successful treatment of livedoid vasculopathy with rivaroxaban

Livedoid vasculopathy is a disorder which is thought to be caused by systemic dysregulation of coagulation, resulting in the formation of fibrin thrombi in the superficial dermal plexus. Chronic disease often results in painful, punched out ulcerations and atrophie blanche on the lower extremities, predisposing affected patients toward infection and high morbidity. Treatment of livedoid vasculopathy is controversial and often ineffective. Owing to the postulated pathophysiology, rivaroxaban recently was suggested as a treatment modality and seems to induce significant improvement in some patients. Herein, we report the successful treatment of recalcitrant livedoid vasculopathy in one patient with no identifiable coagulopathy and propose that a therapeutic trial of rivaroxaban may be helpful in patients with no detectable underlying coagulability disorders. Further evidence of clinical efficacy is needed to confirm the benefit of rivaroxaban in patients with livedoid vasculopathy.