Rivaroxaban, an oral direct factor Xa inhibitor anticoagulant, has emerged as a significant therapeutic option in dermatological conditions associated with thrombosis. While its primary FDA approvals centre on venous thromboembolism prevention and treatment, its utility in cutaneous disorders requires focused attention from dermatologists. Rivaroxaban demonstrates significant efficacy in livedoid vasculopathy, with pain reduction typically occurring within 1 week, and ulcer healing by 4–6 weeks. It shows promise in calciphylaxis when used as part of multimodal therapy, though experience is limited. In purpura fulminans and antiphospholipid syndrome, rivaroxaban presents an alternative to traditional anticoagulants, with specific considerations for patient selection. Rivaroxaban offers several advantages over traditional anticoagulants in dermatological practice, such as fixed dosing, oral administration, and not requiring routine monitoring. However, limitations exist regarding reversal agents to counteract the haemorrhagic complications of rivaroxaban. As clinical experience grows and reversal agents become available, rivaroxaban’s role in dermatological disorders may expand further.