Management of Livedoid vasculopathy through Ayurveda: A case report

Livedoid Vasculopathy (LV) is a rare clinical entity occurring due to vascular occlusion by intraluminal thrombi in the upper and mid dermis. It is characterized by persistent, painful, punched-out ulceration of the legs, especially around the malleoli, and has a typical atrophie blanche. There are several treatment options in conventional care, such as anabolic steroids, antiplatelet, anticoagulant, and intravenous immunoglobulin; however, there is no definitive or standardized treatment approach for its complete cure. In the present case, a 25-year-old female student came to Ayurveda hospital with complaints of bilateral lower limb ulceration, persistent pain, burning sensation at the site of ulcers, and hyperpigmentation in bilateral lower limbs for seven months. The patient was already diagnosed with LV by a rheumatologist in July 2024. The patient reported transient symptom relief only with steroids and anticoagulant therapy, with recurrence after cessation of treatment. The patient was treated on the line of management for Vatarakta (~rheumatism due to vitiated Rakta dosha ), and was managed with Panchakarma (~five internal biocleansing therapies) followed by oral medications along with a prescribed dietary regimen given during the follow-up. After 16 weeks of treatment, ulcers were totally healed, hyperpigmentation decreased along with relief in pain and burning sensation, and the patient was able to stand for a longer duration without any difficulty. Atrophie blanche also got reduced. The Visual Analog Scale score was reduced from 8 to 2, and the Dermatology Life Quality Index score decreased from 10 to 0 after treatment. Moreover, the patient did not require any conventional treatment during this period without exacerbation of symptoms. This case highlights the potential of Ayurveda medicine in managing LV and supports further exploration of individualized, holistic approaches alongside conventional care.