Integrative Chinese-western therapy for Leukocytoclastic vasculitis-induced refractory leg ulcer: An 8-month healing journey with reduced corticosteroid dependency

Abstract

Background

Leukocytoclastic vasculitis (LCV), accompanied by recalcitrant lower-limb ulcers, is frequently treated with corticosteroids or immunosuppressants. However, these treatments often face the formidable challenge of high recurrence risks. Traditional Chinese Medicine (TCM) has been identified as a safe and effective strategy for treating autoimmune vascular diseases. It can serve as an adjunct therapy for recalcitrant wounds caused by this condition, while reducing the dosage of corticosteroids or immunosuppressants.

Case Report

A 60-year-old Asian male presented with a red rash accompanied by pruritus on both feet. Following a lesion to the plantar surface of the right foot, a ulcer formed that exhibited signs of delayed healing and gradually expanded. Subsequent diagnostic procedures revealed the presence of LCV. Despite treatment with prednisone, piperacillin, and cyclophosphamide, the foot ulcer failed to heal. Following an eight-month treatment period that incorporated a Chinese herbal decoction taken orally and low-dose corticosteroids, the ulcer on the patient's right foot exhibited complete healing. During the subsequent 7-month follow-up period, no recurrence of the ulcer was observed.

Conclusion

This case demonstrates that a combination of oral Chinese herbal decoction and low-dose corticosteroids is a highly effective treatment for recalcitrant wounds caused by LCV, with a low recurrence rate. This approach may contribute to a reduction in corticosteroid or immunosuppressant dosage, promote skin ulcer healing, and reduce recurrence rates. The necessity for future randomized controlled trials is evident to ascertain the efficacy of this therapeutic strategy.