Livedoid vasculopathy (LV) is a chronic, relapsing thrombo-occlusive microangiopathy of the dermal vasculature that produces painful ulcers, livedo reticularis, and stellate atrophic scars (atrophie blanche). Recent clinicopathologic evidence emphasises a predominantly thrombotic— not inflammatory—mechanism characterised by fibrin thrombi in small dermal vessels, endothelial injury, and secondary tissue ischemia. Management should be individualised and tiered: anticoagulation (warfarin, direct oral anticoagulants, or low-molecular-weight heparin) is first-line to address the core thrombotic process; antiplatelet agents and vasodilators support microcirculatory flow; immunomodulators (corticosteroids, IVIG, hydroxychloroquine) target autoimmune contributors; and refractory disease may require biologics or targeted small molecules. Emerging options such as selective JAK1 inhibition (reported with upadacitinib), TNF-α blockade, hyperbaric oxygen, and plasmapheresis show promise for treatment-resistant cases but lack randomised controlled trial evidence. Rehabilitation encompassing multimodal pain management, physiotherapy with offloading and gait training, compression therapy where appropriate, advanced wound care, and psychosocial support is essential to restore function and quality of life, yet remains poorly standardised. Future priorities include biomarker-driven stratification to personalise therapy, prospective trials of novel agents and combinations, and development of standardised rehabilitation protocols with longitudinal outcome assessment to reduce recurrence and disability.

Vaidya Bala is a Medical Co-Director for Population and Public Health at the Illawarra and Shoalhaven Local Health District Hospitals and a Senior Staff Specialist in Rehabilitation Medicine at The Wollongong Hospital, Wollongong, NSW, Australia. He is pursuing a Population Health Doctorate at Campbell University, NC, USA. He has published 12 papers in international peer-reviewed journals and presented at various international conferences since 2005.He is currently an examiner with the Royal Australasian College of Physicians for the Faculty of Rehabilitation Medicine and a Senior lecturer at the University of Wollongong.