A case of livedo vasculopathy

Case scenario

Clare, aged 62 years and a new patient at the practice, came to request a narcotic script to deal with the pain from her long-term problem of ‘livedo vasculopathy’. She said that this had started during a pregnancy when she was 25 years old and that despite taking prophylactic medication, she has had recurrent attacks a few times a year ever since.

The pattern was that first she would develop intense pain in both lower legs, and then areas of skin on her legs would break down and form shallow and painful ulcers, which eventually healed leaving scars.

She appeared to have adequate peripheral circulation and was slim, active and a nonsmoker. She regularly took as prophylaxis aspirin, colchicine and indomethacin. No screening tests or other investigations had been performed.

What is the aetiology of this condition? Has Clare been treated appropriately?