Idiopathic Atrophie Blanche: Treatment With Low-Dose Heparin

To the Editor.—  Idiopathic atrophie blanche is a distinct entity characterized by recurrent painful ulcerations on the feet and lower legs. This clinical syndrome has been called atrophie blanche en plaque, livedo reticularis with ulcerations, livedoid vasculitis, and the vasculitis of atrophie blanche,¹ but it is more correctly a vasculopathy rather than a true vasculitis.² The lesions begin with purpuric papules and plaques and, ultimately, leave white, atrophic stellate scars after the ulcers heal. The lesions are produced when fibrin deposition blocks dermal blood vessels, causing ischemic necrosis. Larger blood vessels are not involved, and there is no associated systemic disease. Treatment with phenformin hydrochloride and ethylestrenol to promote lysis of fibrin and restore blood flow is effective,^2,3 but alternative therapy is needed now that phenformin is no longer available in the United States or Canada.Anticoagulant therapy may provide such an alternative. Earlier reports have shown