Livedoid vasculopathy (LV) is a chronic disease characterized by recurrent painful ulcers of lower extremities. Therapeutic options usually include anti-inflammatory or immunosuppressive agents. However, management is still difficult and there is no consensus on the first treatment of LV. We report a case of refractory LV which is successfully treated by hyperbaric oxygen therapy (HBOT). A 61-year-old female presented multiple painful ulcers, atrophic blanches and retiform purpura on both lower legs and feet. The histopathology revealed hyalinized vascular wall, luminal occlusion of the vessels and fibrinoid necrosis. She was diagnosed with livedoid vasculopathy and treated with systemic corticosteroid, antihistamine, antibiotics, pentoxifylline and aspirin. After 6 months of treatment, skin lesions were not improved. Therefore, HBOT was performed at 2.8 atm for 120 to 150 minutes at a time, three times a week. After 4 cycles of HBOT, ulcers began to heal and skin lesions were almost completely cured after 13 cycles. During the follow-up period of 8 months, no new lesions developed and the symptoms remained stable. In conclusion, we suggest that HBOT can be an alternative treatment for refractory LV.