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Failure of Livedoid Vasculitis to Respond to Tissue Plasminogen Activator

Failure of Livedoid Vasculitis to Respond to Tissue Plasminogen Activator Abstract Recently, low-dose intravenous recombinant tissue plasminogen activator (t-PA) was reported as a safe and effective treatment for refractory livedoid vasculitis,1 also known as atrophie blanche or PURPLE. (Milstone et al2 proposed a unifying terminology for the multiple presentations of patients with the syndrome, PURPLE, for ''painful purpuric ulcers with reticular patterning on the lower extremities.'') Some patients with PURPLE may have defective release of endogenous t-PA or increased levels of t-PA inhibitor in plasma.3 A specific fibrinolytic factor produced by endothelial cells, t-PA, given over a period of days in smaller doses than when given as a single dose for myocardial infarction, might lyse small cutaneous thrombi (which appear to be a major factor in the pathogenesis of PURPLE). Klein and Pittelkow1 gave 10 mg of t-PA intravenously over a 4-hour period for 14 days with or without aspirin and heparin. Five of six patients were References 1. Klein KL, Pittelkow MR. Tissue plasminogen activator for treatment of livedoid vasculitis . Mayo Clin Proc. 1992;67:923-933.Crossref 2. Milstone LM, Braverman IM, Lucky P, Fleckman P. Classification and therapy of atrophie blanche . Arch Dermatol. 1983;119:963-969.Crossref 3. Pizzo SV, Murray JC, Gomas SL. Atrophie blanche: a disorder associated with defective release of t-PA . Arch Pathol Lab Med. 1986;110:517-519. 4. Bard JW, Winkelmann RK. Livedo vasculitis: segmental hyalinizing vasculitis of the dermis . Arch Dermatol. 1967;96:489-499.Crossref 5. Winkelmann RK, Schroeter AL, Kierland RR, Ryan TM. Clinical studies of livedoid vasculitis (segmental hyalinizing vasculitis) . Mayo Clin Proc. 1974; 49:746-750. 6. Gilliam JN, Herndon JH, Prystowsky SD. Fibrinolytic therapy for vasculitis of atrophie blanche . Arch Dermatol. 1974;109:664-667.Crossref 7. Fearnley GR, Chakrabarti R. Pharmacological enhancement of fibrinolytic activity of blood . J Clin Pathol. 1964;17:328-332.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Failure of Livedoid Vasculitis to Respond to Tissue Plasminogen Activator

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690140117029
Publisher site
See Article on Publisher Site

Abstract

Abstract Recently, low-dose intravenous recombinant tissue plasminogen activator (t-PA) was reported as a safe and effective treatment for refractory livedoid vasculitis,1 also known as atrophie blanche or PURPLE. (Milstone et al2 proposed a unifying terminology for the multiple presentations of patients with the syndrome, PURPLE, for ''painful purpuric ulcers with reticular patterning on the lower extremities.'') Some patients with PURPLE may have defective release of endogenous t-PA or increased levels of t-PA inhibitor in plasma.3 A specific fibrinolytic factor produced by endothelial cells, t-PA, given over a period of days in smaller doses than when given as a single dose for myocardial infarction, might lyse small cutaneous thrombi (which appear to be a major factor in the pathogenesis of PURPLE). Klein and Pittelkow1 gave 10 mg of t-PA intravenously over a 4-hour period for 14 days with or without aspirin and heparin. Five of six patients were References 1. Klein KL, Pittelkow MR. Tissue plasminogen activator for treatment of livedoid vasculitis . Mayo Clin Proc. 1992;67:923-933.Crossref 2. Milstone LM, Braverman IM, Lucky P, Fleckman P. Classification and therapy of atrophie blanche . Arch Dermatol. 1983;119:963-969.Crossref 3. Pizzo SV, Murray JC, Gomas SL. Atrophie blanche: a disorder associated with defective release of t-PA . Arch Pathol Lab Med. 1986;110:517-519. 4. Bard JW, Winkelmann RK. Livedo vasculitis: segmental hyalinizing vasculitis of the dermis . Arch Dermatol. 1967;96:489-499.Crossref 5. Winkelmann RK, Schroeter AL, Kierland RR, Ryan TM. Clinical studies of livedoid vasculitis (segmental hyalinizing vasculitis) . Mayo Clin Proc. 1974; 49:746-750. 6. Gilliam JN, Herndon JH, Prystowsky SD. Fibrinolytic therapy for vasculitis of atrophie blanche . Arch Dermatol. 1974;109:664-667.Crossref 7. Fearnley GR, Chakrabarti R. Pharmacological enhancement of fibrinolytic activity of blood . J Clin Pathol. 1964;17:328-332.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 1995

References