On the differential diagnosis of ulcerative livedoid vasculopathy

The management of livedoid vasculopathy remains one of the most critical and challenging issues in modern dermatovenerology. Although the etiopathogenetic mechanisms of this disease remain insufficiently studied, their elucidation is essential for developing effective therapeutic strategies and determining the nosological classification of livedoid vasculopathy among other dermatological pathologies. Refining the understanding of its pathogenesis and establishing clear diagnostic criteria will improve differential diagnosis, reduce the time required for disease verification, and ultimately enhance patients' quality of life through the application of combined treatment approaches. This article presents a clinical case of a 56-year-old female patient with a prolonged course of livedoid vasculopathy, complicated by non-insulin-dependent diabetes mellitus and genetically determined thrombophilia due to multiple hemostatic system mutations. The diagnostic process included differential diagnosis with ulcerative-necrotic polymorphic dermal angiitis and chronic venous ulcers. Comprehensive examination confirmed the final diagnosis of livedoid vasculopathy. This case highlights the importance of an extensive diagnostic workup in patients with chronic ulcerative skin lesions, which is crucial for accurate and timely diagnosis and the initiation of pathogenetically grounded therapy. Special emphasis is placed on the necessity of considering concomitant thrombophilia in the management of such patients.