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Atrophie blanche

Gabriela Franco Marques, Paulo Ricardo Criado, Thâmara Cristiane Alves Batista Morita, María Salomé Cajas García
Livedoid vasculopathy (LV) is a thrombotic skin disease characterized by episodic painful ulcerations of the distal aspects of the legs. Its healing process typically leaves small porcelain-white scars called atrophie blanche as a result of the occlusion of cutaneous microcirculation. The main goals of the treatment are pain management and the prevention of ulceration and of progressive scarring in the malleolar area. The therapeutic management is still a challenge, however, and most treatments were based on anecdotal off-label protocols...
April 16, 2018: International Journal of Dermatology
Shintaro Akiyama, Masakazu Nagahori, Shinya Oooka, Mariko Negi, Takashi Ito, Kento Takenaka, Kazuo Ohtsuka, Mamoru Watanabe
RATIONALE: The small intestine (SI) does not commonly harbor cancer but is occasionally involved by metastatic cancer from other organs. To manage SI cancer appropriately, surveillance for primary origin outside the SI is essential. PATIENT CONCERNS: This study presents a 54-year-old Thai man diagnosed with SI obstruction which required laparoscopy- assisted partial ileal resection. DIAGNOSES: On the basis of the expression pattern of cytokeratins (CKs) and mucins (MUCs) in the resected SI adenocarcinoma, we suspected this was metastasized from the pancreatobiliary tract...
March 2018: Medicine (Baltimore)
Heather Reagin, Etan Marks, Stephen Weis, Joseph Susa
We report a case in which a 43-year-old African American male with medical history of sickle cell disease (SCD) presented with a nonhealing ulcer. Biopsy revealed features of livedoid vasculopathy. Previously, livedoid vasculopathy had only been described in a patient with sickle cell trait, but never in a patient with SCD. Livedoid vasculopathy most commonly affects the distal lower extremities and is characterized by irregular, punched-out, painful ulcers that heal with stellate white scars of atrophie blanche...
February 28, 2018: American Journal of Dermatopathology
V M López Escárraga, K Dubos España, R H Castillo Bustos, L Peidró, S Sastre, X Sala-Blanch
INTRODUCTION: Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block. PATIENTS AND METHODS: We designed an observational study in 22 patients scheduled for shoulder arthroscopy...
February 2018: Revista Española de Anestesiología y Reanimación
Stephen Chu-Sung Hu, Gwo-Shing Chen, Chi-Ling Lin, Yang-Chun Cheng, Yung-Song Lin
Livedoid vasculopathy (atrophie blanche) is a form of thrombotic vasculopathy. It is characterized by small ulcers that become crusted, and heal after several months to produce white atrophic scars. The most commonly affected sites are the lower legs, in particular the dorsum of the feet and ankles. To date, the dermoscopic features of livedoid vasculopathy have not been clearly described in the literature. In this observational study, we sought to evaluate the dermoscopic patterns of livedoid vasculopathy and determine whether the dermoscopic features are associated with certain histopathological characteristics...
March 2017: Medicine (Baltimore)
Victoria K Shanmugam, Divya Angra, Hamza Rahimi, Sean McNish
OBJECTIVE: Chronic wounds are a major cause of morbidity and mortality. Approximately 20% to 23% of nonhealing wounds that are refractory to vascular intervention have other causes, including vasculitis, pyoderma gangrenosum, and other autoimmune diseases. The purpose of this article was to review the literature across medical and surgical specialties with regard to refractory chronic wounds associated with vasculitis and autoimmune diseases and to delineate clinical outcomes of these wounds in response to vascular and other interventions...
March 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
André Tavares Somma, Juan Carlos Duque Moreno, Mario Teruo Sato, Blanche Dreher Rodrigues, Marianna Bacellar-Galdino, Laurence Mireille Occelli, Simon Michael Petersen-Jones, Fabiano Montiani-Ferreira
OBJECTIVE: To describe a form of progressive retinal atrophy (PRA) in Whippets including clinical, electroretinographic, optical coherence tomographic changes and pedigree analysis. ANIMALS STUDIED: Client-owned Whippet dogs (n = 51) living in Brazil. PROCEDURES: All animals were submitted for routine ophthalmic screening for presumed inherited ocular disease, which included the following: visual tests, such as obstacle course tests, in scotopic and photopic conditions, cotton ball test, dazzle reflex, ocular fundus evaluation by indirect ophthalmoscopy followed by fundus photography...
November 29, 2016: Veterinary Ophthalmology
Biju Vasudevan, Shekhar Neema, Rajesh Verma
Livedoid vasculopathy is a rare cutaneous disease manifesting as recurrent ulcers on the lower extremities. The ulceration results in atrophic, porcelain white scars termed as atrophie blanche. The pathogenesis is yet to be understood with the main mechanism being hypercoagulability and inflammation playing a secondary role. The important procoagulant factors include protein C and S deficiency, factor V Leiden mutation, antithrombin III deficiency, prothrombin gene mutation and hyperhomocysteinemia. Histopathology of livedoid vasculopathy is characterized by intraluminal thrombosis, proliferation of the endothelium and segmental hyalinization of dermal vessels...
September 2016: Indian Journal of Dermatology, Venereology and Leprology
Paulo Ricardo Criado, Gabriela Franco Marques, Thamara Cristiane Alves Batista Morita, Jozélio Freire de Carvalho
UNLABELLED: Cutaneous polyarteritis nodosa (CPAN) is a rare disease that affects small and middle caliber vessels of the deep dermis and subcutaneous tissue and its etiopathology remains yet to be understood. METHODS: Retrospective review of twenty two cases diagnosed as CPAN and confirmed by skin biopsy over the last 11 years was evaluated in our department. RESULTS: We found predominance in white woman, mean age of 39.4 years, showing no comorbidities in most of our sample...
June 2016: Autoimmunity Reviews
Juan Monreal
BACKGROUND: Lower extremity asymmetries are challenging problems in plastic and aesthetic surgery practice. Regardless of their origin, atrophies and asymmetries can be extremely varied and difficult to solve with simple techniques. OBJECTIVES:   The author reports his experience in the treatment of four patients suffering from severe lower extremity atrophy and asymmetry of different etiologies with autologous fat grafting. METHODS: A total of four cases are presented...
2015: Curēus
Elizabeth McVittie, Samantha Holloway
The presence of chronic venous insufficiency results in venous hypertension, which can lead to the development of venous leg ulceration. Patients often present with oedema of the lower limb and skin changes, for example, the presence of haemosiderin and lipodermatosclerosis, as well as ulceration. In some instances, patients can also develop atrophie blanche (AB)-white fibrotic areas on the skin adjacent to the ulcer. AB remains an ambiguous term owing to the use of many synonyms. Hence, health professionals need to be aware of the clinical presentation of AB and should be able to clearly differentiate between scarring caused by previous ulcers and that caused by the presence of AB...
December 2015: British Journal of Community Nursing
Merce Avellanet, Xavier Sala-Blanch, Lidia Rodrigo, Miguel A Gonzalez-Viejo
Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further...
February 2016: Journal of Clinical Monitoring and Computing
Afsaneh Alavi, Jurg Hafner, Jan P Dutz, Dieter Mayer, R Gary Sibbald, Paulo Ricardo Criado, Patricia Senet, Jeffery P Callen, Tania J Phillips, Marco Romanelli, Robert S Kirsner
PURPOSE: The purpose of this learning activity is to provide information about the etiology and treatment of atrophie blanche. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Discuss the pathophysiology of atrophie blanche.2. Explore treatment options for livedoid vasculopathy...
November 2014: Advances in Skin & Wound Care
İpek Eroğlu, Erkan Azizoğlu, Mine Özyazıcı, Merve Nenni, Hande Gürer Orhan, Seda Özbal, Işıl Tekmen, İlgen Ertam, İdil Ünal, Özgen Özer
Atopic dermatitis (AD) is a chronic and relapsing skin disease with severe eczematous lesions. Long-term topical corticosteroid treatment can induce skin atrophy, hypopigmentation and transepidermal water loss (TEWL) increase. A new treatment approach was needed to reduce the risk by dermal targeting. For this purpose, Betamethasone valerate (BMV)/Diflucortolone valerate (DFV)-loaded liposomes (220-350 nm) were prepared and incorporated into chitosan gel to obtain adequate viscosity (∼13 000 cps). Drugs were localized in stratum corneum + epidermis of rat skin in ex-vivo permeation studies...
June 2016: Drug Delivery
Mariana Quirino Tubone, Gabriela Fortes Escobar, Juliano Peruzzo, Pedro Schestatsky, Gabriela Maldonado
Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis...
November 2013: Anais Brasileiros de Dermatologia
Paulo Ricardo Criado, Afsaneh Alavi, Ilana Halpern, Mirian Nacagami Sotto, Robert S Kirsner
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 A→G genotype of prothrombin, reduced activity of anticoagulation proteins C and S, and elevated lipoprotein (a)...
December 2013: International Journal of Lower Extremity Wounds
Afsaneh Alavi, Jürg Hafner, Jan P Dutz, Dieter Mayer, R Gary Sibbald, Paulo Ricardo Criado, Patricia Senet, Jeffery P Callen, Tania J Phillips, Marco Romanelli, Robert S Kirsner
Livedoid vasculopathy (LV) is a noninflammatory thrombotic condition presenting in a primary idiopathic or secondary subtype associated with abnormal coagulation factors. Different from atrophie blanche (AB), which is a clinical manifestation of certain scars, LV may have AB in combination with recurrent livedo reticularis with chronic and painful skin ulcers particularly around the ankle region, and at the back of the feet. Histology is characterized by segmental hyalinizing changes at the subintimal region of small dermal vessels with thrombotic occlusions...
December 2013: Journal of the American Academy of Dermatology
Nina Kerk, Tobias Goerge
Livedoid vasculopathy is a rare, chronic occlusive disease of vessels supporting the upper layers of the skin. It is characterized by purpuric maculae and recurrent painful ulcerations mostly affecting the lower leg. These ulcerations occur episodically especially in summer time and heal slowly, leaving characteristic porcelain-white scars called ’atrophie blanche’.This review is focused on the current knowledge on livedoid vasculopathy and modern therapy strategies resulting from its etiopathogenetic associations with prothrombotic states...
September 2013: VASA. Zeitschrift Für Gefässkrankheiten
A Becker, M Stoffels-Weindorf, T Schimming, J Dissemond
HISTORY AND ADMISSION FINDINGS: A 50-year-old women had suffered from recurrent and extremely painful ulcerations of both legs and the back of her feet for about 3 weeks. The clinical examination showed multiple hemorrhagic and bizarre configured ulcerations with a surrounding livid-erythematous discoloration, hyperpigmentation and extensive atrophie blanche. INVESTIGATIONS: Neither instrument-based nor serological tests revealed specific pathological findings. Histological results from the border area of the ulceration confirmed the diagnosis of livedoid vasculopathy...
July 2013: Deutsche Medizinische Wochenschrift
Laura A Thornsberry, Kristen I LoSicco, Joseph C English
Hypercoagulable states (HS) are inherited or acquired conditions that predispose an individual to venous and/or arterial thrombosis. The dermatologist can play a vital role in diagnosing a patient's HS by recognizing the associated cutaneous manifestations, such as purpura, purpura fulminans, livedo reticularis, livedo vasculopathy (atrophie blanche), anetoderma, chronic venous ulcers, and superficial venous thrombosis. The cutaneous manifestations of HS are generally nonspecific, but identification of an abnormal finding can warrant a further workup for an underlying thrombophilic disorder...
September 2013: Journal of the American Academy of Dermatology
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