Treatment options for Livedoid Vasculopathy (LV)

Posted by zenk @zenk, Mar 19, 2014

I am looking for outcomes in the use of blood thinners in the treatment of Livedoid Vasculopathy

Interested in more discussions like this? Go to the Skin Health group.

I have started on Xarelto 15 mg for LV today . Am looking for what I might expect for my LV ulcers regarding healing or not. Thanks, Zenk

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@zenk

I have started on Xarelto 15 mg for LV today . Am looking for what I might expect for my LV ulcers regarding healing or not. Thanks, Zenk

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Hi @zenk. Here is some information about the side effects of Xarelto: http://www.mayoclinic.org/drugs-supplements/rivaroxaban-oral-route/side-effects/drg-20075013. Hope this is helpful.

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I have been suffering with LV for 6 years. The open ulcer I have now on my foot is getting bigger and very painful. I am on Xarelto 15 mg and have been seeing wound care on a regular basis. Has IVIG helped close existing ulcers for any of you? Thanks, Zenk

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Has anyone had any experience with the use of the drug CellCept in treatment of skin ulcers from Lividoid Vasculopathy? Interested in any successes, failures and side effects. Have tried other drugs such as Azathioprine (bad side effects), methotrexate (moderate side effects) and Plaquenil (virtually no side effects) but none have been effective in closing the LV ulcers. So far have been denied CellCept by ins because LV is not a labeled use. It is very expensive w/o insurance and I would like to know of any successful use for LV. Thanks.

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Hi @gonefishinmt,
I thought it might be helpful to merge the new thread you started with the threads started by fellow Connect member @zenk in the hopes that you have treatment option experiences to share.

You may also be interested in reading this discussion thread https://connect.mayoclinic.org/discussion/livedoid-vasculopathy/ where you’ll meet @angelasmom, @spence, @prairiesmoke and @mlemieux.

I hope they’ll be able to shed some light on your question about the drug CellCept and any other questions you may have.

Colleen
Connect Community Director

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Hi @gonefishinmt ,

Here in Canada, we don’t have CellCept offered here (not in my area anyways), but it’s another “immunosuppressive agent” type of drug which is very similar to “Prednisone”, which “Prednisone” is often used to help with flare-ups with Vasculitis patients, NOT LV patients. They are VERY similar conditions, but actually have opposite effects and medications.

My doctors put me on Prednisone for almost 2-years not realizing that I did not have Vasculitis, but the opposite LV. And I will tell you that Prednisone and other type drugs are NOT to be meddled with, I literally felt major changes inside, not related to my legs. Sleep was all but NULL and even my family members noticed a major difference in my personality.

If anyone ever recommended a similar drug again, it would have to mean that I have no options left in life in order to get me to ever take this medication again. Please do your research and once you have all the facts, then pursue taking this medication under strict supervision. Remember, these class of drugs make you more susceptible to other infections and usually have to be on a strict regiment.

Before you go spending money you may not have on a drug you don’t need… find communities concerning “Vasculitis” patients to see if they have been prescribed your CellCept.

Good luck with everything, stay positive 🙂

Martin R. Lemieux
@martin_lemieux

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Martin – Thanks so much for sharing your history with LV. It seems we have a remarkably similar past. My diagnosis has vacillated between Vasculitis and Vasculopathy for the past 3 years or so and recently has settled on Lividoid Vasculopathy based on a number of factors determined from a whole lot of lab work and biopsies. I have been on prednisone of various doses and tapers for nearly 2 years and it is the only thing so far that will keep the swelling in check. I have also had courses of several other drugs including Allopurinol and Colchicine (primarily gout meds but in use for vasculitis), Hydroxy-chloroquine (Plaquenil), Methotrexate and Azathioprine (Imuran) plus a whole list of topical crèmes. For pain I was on a large dose of Gabapentin (Neurontin) in addition to Oxycodone and several different antibiotics. Like you, I experienced physical and personality changes that were very much noticed by family members.
I have now returned to Plaquenil, Colchicine and a low maintenance dose of Prednisone the combination of which has few side effects. Imuran was the worst for side effects including very painful ulcers in my mouth and on my tongue. CellCept was thought to be effective but with fewer side effects than Imuran. Its a moot point however, as CellCept is labeled only for use with autoimmune diseases such as Lupus and Medicare wouldn’t budge in its refusal to approve it for my case. Autoimmune disease has been ruled out for me based on lab tests conducted over the past two years.
I agree completely with you as does my wife in terms of not trying any new and expensive drugs without some assurance that it will yield positive results. As you point out, Prednisone is bad enough and I’ve tried to wean off of it several times only to suffer from serious swelling (edema) and reopening ulcerations. You are also right about being vulnerable to every bug that comes along when taking immuno-suppressants for long periods. I ended up in the hospital with pneumonia a couple of months ago when taking Imuran. The pneumonia caused heart stress because of low oxygen transfer which then triggered an episode of SVT (supra-ventricular tachycardia). While there I also acquired an infection of Enterobacter aerogenes in a large existing ulcer on my ankle. Imuran is nasty and wasn’t very effective in treating LV.
I would like to hear what treatments have proven effective for your situation.
Thanks again for your post.

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@zenk

I have been suffering with LV for 6 years. The open ulcer I have now on my foot is getting bigger and very painful. I am on Xarelto 15 mg and have been seeing wound care on a regular basis. Has IVIG helped close existing ulcers for any of you? Thanks, Zenk

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Zenk – I’ve not tried either of those meds so have no experience with them. This week, my doc is trying to get approval to use a wound cover made of sheep placenta membrane. I’ll let everyone know whether it is effective after I’ve used it for a while.

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Hi @gonefishinmt ,

I hope it doesn’t bother you too much when I say with all kindness, it’s nice to know I’m not the only one trying to battle and un-fair fight with this illness.

Over the years, we have tried almost anything. Unfortunately for me, battling LV is almost deemed impossible…since at 1st, I suffer from many DVT’s (Deep Vein Thrombosis) from a hereditary condition called Factor V. Which ultimately means I’m prone to clotting for life. Not being on blood thinners is not an option for me. When I was younger, I was put on studies for “Coumadin” to make the drug generic world wide. Ironically, I’m not a fan of Coumadin what so ever after years of taking the medication. There are many side effects that are unnecessary due to the other options available nowadays.

Pentoxifylline:
I was put on this medication to help blood flow, which in my case is greatly needed. This too had zero results, but might prove effective in your case.

Low-Molecular Weight Heparin:
Have you explored “Heparin” injections yet? Low-Molecular Weight Heparin. For me this too unfortunately did nothing since my clotting factor played against my ability to heal long-term wounds on both legs and at the same time, counter the effects of LV. But for yourself, this one of the few options available in a short list of recommendations made by professionals world wide.

The one downside is that you will be required to inject yourself on a daily basis. Over time, my stomach became extremely bruised and hardened which prevented me from being able to inject into my stomach any further. From there your options are to inject directly into your upper thighs (pinching the skin).

Hyperbaric Oxygenation Therapy:
One of the better options after medication(s) have been exhausted, is by directing pure oxygen into your vascular system to help speed up the healing process on the exterior and interior where ulcers not seen by the human eye can fester and cause a great deal of pain. Again, due to my other conditions (swelling/inflammation/deteriorating arteries), this proved to be somewhat ineffective as well. BUT, don’t take my failure as your own. Hyperbaric Oxygen Therapy can provide all sorts of useful healing, in fact professional sports players use oxygen tanks all the time to speed up the healing process. I’m not sure what your medical insurance will think of it, since it tends to be very expensive, but it’s definitely worth a shot. Above all medications and procedures I’ve tried over the years, this one proved to be the most promising.

Other Therapies:
Basically, to help your research, search for “Livedoid Vasculopathy Treatments”. There’s a small but thorough report which my specialists are going through one by one trying all the treatments detailed in this dermatologist report on studies and findings.

—–

Dealing with Pain & Swelling:
(TALK TO YOUR DOCTOR OF COURSE 🙂

After many years throughout my life dealing with pain, swelling, bleeding, etc. The below combination of medications have proved most effective for pain management while dealing with our type of illnesses and side effects (The below med’s have been taken over the years to help at various stages, but are not an exact list of what I take now since I’ve learned to deal with the pain better through more holistic methods):

Inflammation – Naproxen 500mg x2 daily:
Naproxen is by far the best to help with the swelling, especially first thing in the morning and at night before bed. the only downside is that it kills your stomach, so you will be forced to take something to help with stomach pain, bloating, etc. I have found “Tecta (brand) aka Pantoprazole” 40mg x2 daily to be the best solution in order to counteract the effects of Naproxen.

Nerve Pain – Tizanidine 4mg x2 daily:
For me, after years of battered arteries and muscle deterioration, my nerves have been intertwined and cause a great deal of pain. I would get spikes of pain so bad that nothing would help. This one medication changed all of that. No real side effects to mention, just a relief from nasty pain-spikes.

Pain ( level 6/10 ) – Oxycocet aka Percocet’s x4-6 daily:
This is my bread and butter since percocet’s don’t have too many side effects, especially when it comes to daily interactions and sound living. I’ve learned to take these when needed throughout the day to help minimize any discomfort from daily tasks. Results vary from each person of course, I try to keep my mind fresh and coherent which percocet’s help with that.

Pain ( level 7-10/10) – Hydromorph or Oxycodone / Oxycontin x2 daily:
For severe pain, unfortunately we need to turn to narcotic type drugs, which I’ve done everything in my power to stay away from. In my early years, I was taking Oxy’s twice daily, but ended up with migraines and terrible sleeping habits, not to mention sometimes having a foggy mind (never fond of). I found Hydromorph to be less intrusive, but still has it’s complications of course since both can be addictive.

Like all meds, i’m sure you’ve found what works best for you.

MEDITATION:
I can’t stress enough the benefits I’ve found from meditating 10-15 minutes daily. Everything seems to hurt less and my body seems more in tune now that I meditate. Getting sick on a regular basis has been minimal at best. And of course, you don’t need to sit there in silence in an awkward pose, merely sitting with your eyes shut to some nice music can have the same effect.

——

That’s about it 🙂 Take what you need, I truly hope this helps you find healing methods you haven’t tried, or if anything, helps to find ways to minimize the pain and live a better life.

I hope this helps!
Please keep us posted and thank you for sharing your story as well.

Cheers!
Martin
@Martin_Lemieux – Tweet

Disclaimer: OBVIOUSLY i’m not a doctor, so consult someone with a shiny plaque on their wall 🙂

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Martin:
Thanks – that’s heck of a lot of really good information you’ve provided. I’ll discuss these alternatives with my doc next week. You have a wealth of experience that I’m sure all of us LV folks really appreciate you’re having shared.
Thanks again

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You’re very welcome @gonefishinmt . I have a lot more to share, but held back a little so not to overwhelm anyone looking in. Let me know how these suggestions go with your health care specialist. I can/will provide with more suggestions that me and my specialists have tried in the past.

I truly one of these are the key for you!

Sincerely,
Martin R. Lemieux
@Martin_Lemieux

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@mlemieux

Hi @gonefishinmt ,

Here in Canada, we don’t have CellCept offered here (not in my area anyways), but it’s another “immunosuppressive agent” type of drug which is very similar to “Prednisone”, which “Prednisone” is often used to help with flare-ups with Vasculitis patients, NOT LV patients. They are VERY similar conditions, but actually have opposite effects and medications.

My doctors put me on Prednisone for almost 2-years not realizing that I did not have Vasculitis, but the opposite LV. And I will tell you that Prednisone and other type drugs are NOT to be meddled with, I literally felt major changes inside, not related to my legs. Sleep was all but NULL and even my family members noticed a major difference in my personality.

If anyone ever recommended a similar drug again, it would have to mean that I have no options left in life in order to get me to ever take this medication again. Please do your research and once you have all the facts, then pursue taking this medication under strict supervision. Remember, these class of drugs make you more susceptible to other infections and usually have to be on a strict regiment.

Before you go spending money you may not have on a drug you don’t need… find communities concerning “Vasculitis” patients to see if they have been prescribed your CellCept.

Good luck with everything, stay positive 🙂

Martin R. Lemieux
@martin_lemieux

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I have had coumadin (warfarin, ie. rat poison) twice for blood clots and
also the injectable blood thinner that is given for clots in the lung.
Neither seemed to affect the formation of the LV ulcers. The aspirin I take
doesn’t seem to do anything for the ulcer, but the incidence of blood clots
had gone way down. I have factor V Leyden, which makes me a good candidate
for clots and also for LV.

My father was on prednisone for a short time to try to reduce a lung
inflamation. His personality went from that of a stoic Sweed to that of a
wild Irishman. The inflamation also got worse. We finally had a lung biopsy
done and he had Mycobacterium avei (bird TB). The prednisone did nothing
for the infection but make it worse.

I have had prednisone creams, and eye drops for allergies. Benadryl works
better on topical allergies than prednisone, and the eye drops precipitated
local retinal detachment. I read all ingredients and look at chemical
structures on all medicines, creams, topicals that I take. Doctors keep
thinking that I must be diabetic because of the LV ulcer, and they try to
apply bandages, and compresses like duoderm, xeroform, etc that may work
for diabetic ulcers but only serve to aggravate an LV ulcer. Drs are well
meaning but LV is rare so we get treated for problems other than LV, and
the treatments often damage our ulcers to the point that they become
increasingly difficult to manage.

Sheila

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