Case Report by Tod Mikuriya, MD

Introduction: Atrophie blanche / livedoid vasculitis, is a chronic non-palpable primary cutaneous purpuric clotting disorder with petechiae of autoimmune etiology. Clinically, there is recurrent breakdown of tissue with edema, pain, and secondary infection.

Method: L.H.R., 56 year old single caucasian accountant was evaluated for eligibility for the California Compassionate Use Act.

History: He contracted this rare condition after infection of his feet. While incarcerated in prison he abstained from using cannabis. The condition gradually worsened for the next four years until his release from a halfway house. (A course of antihypertensive drugs may have also aggravated during the onset stages.) He underwent venous stripping and numerous courses of topical and systemic antibiotics without relief. The recurrent attacks of painful breakdown of skin and underlying tissue with edema caused him to be immobilized and housebound. He experienced significant reactive depression secondary to pain and immobility.

After release he resumed his use of cannabis (begun at age 15). He noted significant relief of symptoms and decreased frequency of attacks using high- grade cannabis smoked twice daily. He is currently maintained on coumadin 5mg daily, digoxin 0.25 mg daily.

Findings: The feet exhibited some thinning, tightening, and rubor of the skin with mild atrophic changes. The patient walked gingerly but with essentially normal gait. Results: Marinol 10 mg 1 – 2 Q6 PRN was begun. The patient reports excellent results using 10 mg BID with no relapses. His depression has gradually lifted, commensurate with his improved mobility.

Conclusion: THC and cannabis would appear to have analgesic immunomodulative and antidepressive properties.

published in O’Shaughnessy’s, Spring 2004