Livedoid vasculopathy managed with hyperbaric oxygen therapy

Livedoid vasculopathy is an uncommon condition resulting in painful lower extremity ulceration and scarring. This condition presents as purpuric macules and papules that progress to painful, irregular ulcers of the lower legs and dorsal feet. These ulcerations are often recurrent and chronic with spontaneous remissions and exacerbations that may be seasonal. The first case, a 22-year-old female presented with three-year history of recurrent multiple non-healing ulcers involving feet and ankles. The ulcers were associated with severe debilitating pain and paraesthesia, as a result of which she was unable to walk without support. Patient was administered HBOT at pressure of 2.5ATA for 1 h daily, six days a week. After ten sittings of HBOT, patient reported a drastic reduction in the pain along with reduction in the dose of analgesic by half and a definite improvement in her walking. The second case was a 49-year-old male who also had history of recurrent ulceration on the dorsum of feet and ankles associated with severe pain. With HBOT, the patient felt an improvement in pain and ambulation by the 8th sitting and complete relief from pain by the 17th sitting. HBOT is a recognized modality of treatment of various problem wounds and non-healing ulcers due to various etiologies. The above two cases show that it can be a useful treatment modality for livedoid vasculopathy where other treatment modalities have failed and therefore could be given to a larger number of patients in hospitals where it is available.