A 26 year old female presented with painful ulcer with greenish discharge on the left foot which started 4 months ago. She has been treated at another university hospital with cyclosporine, methylprednisolone, aspirin, antibiotics for pseudomonas infection, intralesional triamcinolone injection, vacuum assisted negative pressure dressing and hyperbaric oxygen therapy. Her laboratory result was positive for antiphospholipid antibody(APA) and retest was scheduled in 12 weeks to confirm antiphospholipid syndrome. Under the diagnosis as Livedoid vasculopathy(LV), treatment was initiated with oral rivaroxaban, and wound bed preparation(debridement, IV antibiotics for pseudomonas infection and dressing with topical retinoid and topical silver sulfadiazine). After 1 month, we added topical epidermal growth factor and silver coated dressing instead of topical silver sulfadiazine. After 2 weeks, the wound size decreased to 75% of its initial size and the patient was discharged. On 1 month follow up, the wound was completely healed. The lesion showed no sign of recurrence and the retest result came back positive for APA. In this case, the patient was initially diagnosed as pyoderma gangrenosum and treated with immunosuppressive agents and had secondary infection which delayed the wound healing. Based on our previous experience of treatment of LV with rivaroxaban, we could successfully treat this patient with rivaroxaban and wound bed preparation.