Therapeutic use of lowmolecular weight heparin for capillaritis alba

Summary

The reason of the so called ulcerated capillaritis alba or idiopathic atrophie blanche is vasculopathy caused by severe venous hypertension. Thrombosed and rarificated vessels worsen the oxygenation, increase permanent inflammation and impede the necessary compression therapy. The anti-inflammatory effects of heparin alleviate pain and being independent from the antithrombotic ones it needs much lower doses for treatment. This anti-inflammatory effect is now becoming more important in clinical phlebology. Case studies of more than 50 patients and one prospective randomized study of 87 patients clearly demonstrate the ameliorated healing of ulcerated atrophie blanche. In our office we could document this positive effect with 22 patients. We present the pathophysiology of low molecular heparins for ulcerated capillaritis alba and our own experiences with it.

Zusammenfassung

Die ulzerierte Capillaritis alba wird durch eine Livedovaskulopathie im Korium verursacht, die im Rahmen einer ausgeprägten venösen Hypertonie auftritt. Die thrombosierten und rarefizierten Gefäße verschlechtern die Oxygenation, erschweren die Kompression und führen zu einer andauernden schmerzhaften Entzündung. Die Anwendung von niedermolekularem Heparin führt zu Schmerzlinderung durch antientzündliche Heparinwirkungen. Diese antiinflammatorischen Wirkungen, neben den antithrombotischen Wirkungen der Heparine, treten heute in den Vordergrund der Grundlagenforschung und finden langsam auch Berücksichtigung in phlebologischen Studien. Arbeiten mit klinischen Beobachtungen bei über 50 Patienten und eine prospektiv randomisierte Studie mit 87 Teilnehmern belegen eindrucksvoll die verbesserte Ulkusheilung unter Heparin.

In der eigenen Praxis konnte diese positive Wirkung bei 22 Patienten dokumentiert werden. Nach Darstellung der Grundlagen und der eigenen Erfahrungen wird die Anwendung von niedermolekularem Heparin bei der ulzerierten Capillaritis alba diskutiert.

Résumé

L’étiologie de la lésion nommée atrophie blanche idiopathique avec ulcération est une vasculopathie causée par une hypertension veineuse sévère. Des vaisseaux thrombosés et raréfiés diminuent l’oxygénation, accroissent une inflammation permanente et gênent la compression thérapeutique nécessaire. L’effet anti-inflammatoire de l’héparine diminue la douleur et, indépendamment de son effet anti-thrombotique, nécessite de très faibles doses pour le traitement. Cet effet anti-inflammatoire est actuellement reconnu en phlébologie clinique. Une casuistique de plus 50 patients et une étude prospective randomisée de 87 patients démontrent clairement l’amélioration de la cicatrisation de l’atrophie blanche ulcérée. Dans note consultation, nous pouvons documenter cet effet positif avec 22 patients. Nous présentons le traitement par des héparines à bas poids moléculaire pour l’atrophie blanche avec ulcération, ainsi que le résultat de notre expérience.

Keywords

Ulcerated capillaritis alba - vasculopathy - low molecular weight heparin - protective effects of heparin

Schlüsselwörter

Ulzerierte Capillaritis alba - Vaskulopathie - niedermolekulares Heparin - protektive Heparinwirkung

Mots clés

Dermite blanche atrophique ulcérée - vasculopathie - héparine à bas poids moléculaire - effet protecteur de l’héparine

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