Case report: Hyperbaric oxygen therapy at medium pressure to treat livedoid vasculopathy.

Distinguished members of the Biobaric Network together with the Argentine Association of Hyperbaric Medicine and Research, currently part of the IHMERA, published a new clinical case. 

Msc. Alejandro Herrera together with Dr. Maria José Madriagal and Dr. Fabrizio Verdini, medical liaison of Biobarica Hyperbaric Solutions, developed a clinical case of a 26-year-old female patient with a livedoid vasculopathy. This skin disease manifests as recurrent leg ulcers, is characterized as a non-inflammatory thrombus occlusive condition and significantly impairs the quality of life of those who suffer from it. Treatment is usually complex because its pathogenesis is unknown, however, it was found that hyperbaric oxygenation treatment (HBOT) can work effectively as an adjuvant therapy due to the effects triggered by hyperoxia. 

Research suggests that hyperbaric oxygen therapy at medium pressure is a rapid and effective alternative for the treatment of livedoid vasculopathy in patients who do not respond to conventional antiplatelet therapy, immunomodulatory therapy or oral corticosteroids. 

The medical team postulates the case of a woman who, for the past 4 years, has been suffering from multiple recurrent episodes of ankle and foot ulcers. Since the patient reported recurrent dermatitis with small painful ulcers and 4 severe episodes lasting between 2 and 6 months, HBOT was prescribed as an adjuvant treatment. 

She has been prescribed 60-minute sessions at a pressure of 1.45 atmospheres absolute in the Revitalair 430 hyperbaric chamber. The reason why it was decided to use the Biobarica chambers is that an effective pressure is achieved, but safe for the patient and it does not require high maintenance costs like the rigid chambers. During the first two weeks of treatment, the patient had 3 weekly sessions and in the following weeks, the frequency was reduced to twice a week. After 12 sessions, it was observed complete wound healing and a significant reduction in pain.

These improvements are mainly due to the hyperoxia generated by the hyperbaric chamber that counteracts cellular ischemia, the stimulation of collagen synthesis that favors the wound healing process and tissue repair, the analgesic effect and the stimulation of neovascularization. Healthcare professionals conclude that the systemic anti-inflammatory effect of HBOT, and the induction of fibrinolytic molecule synthesis in vessel cells, may have been involved in wound recovery. 

Although more research is required to further investigate the benefits of hyperbaric oxygen therapy to treat livedoid vasculopathy, this clinical case has made a great contribution to the field of hyperbaric medicine due to the complexity of the pathology. Both the Biobarica Network and the International Hyperbaric Medicine and Research Association (IHMERA) are committed to the development of hyperbaric medicine and will continue to conduct research so that patients can benefit from a highly efficient, safe and non-invasive treatment.