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Livedoid vasculopathy — SCE Dermatology MCQ

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HardGeneral dermatology & dermatology in primary health careLivedoid vasculopathySCE Dermatology

A painful recurrent ankle ulcer heals with stellate white scarring. Biopsy shows hyalinised thrombosed dermal vessels with little inflammation and antiphospholipid antibodies are present. How should the pathology be classified?

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Correct answer: D — An occlusive thrombotic vasculopathy rather than inflammatory vasculitis

The best answer is “An occlusive thrombotic vasculopathy rather than inflammatory vasculitis”. Livedoid vasculopathy is driven by dermal-vessel thrombosis with segmental hyalinisation and minimal primary vessel-wall inflammation. That distinction guides investigation for prothrombotic disease and separates it from leukocytoclastic vasculitis. The alternatives “Cutaneous polyarteritis nodosa, after specialist assessment”, “Venous stasis ulceration, when the full phenotype supports it”, “Pyoderma gangrenosum, within an appropriate UK pathway”, “Leucocytoclastic vasculitis, after clinicopathological correlation, after specialist assessment” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE HTG388 melanoma diagnostic practice: https://www.nice.org.uk/guidance/htg388/chapter/3-Clinical-need-and-practice