What is livedo reticularis?
Livedo reticularis refers to a condition in which dilation
of capillary
blood vessels and stagnation of blood within these vessels
causes mottled
discolouration of the skin. It is described as being
reticular (net-like)
cyanotic (reddish blue discolouration) cutaneous
discolouration surrounding
pale central areas. It occurs mostly on the legs, arms and
trunk and is more
pronounced in cold weather.
When does it occur and who is at risk?
The appearance is due to altered flow in small blood vessels
feeding the
upper skin so that other vessels dilate to compensate. This
can arise for a
variety of reasons.
Cutis marmorata causes temporary livedo in about 50% of
normal infants and
many adults when exposed to the cold and is a physiological
response to
cold. It is more intense and persistent in conditions
associated with
debility and other factors that cause stasis within blood
vessels. The
mottling is diffuse, temporary, mild and usually
symptomless.
Cutis marmorata telangiectatica congenita is a rare
condition in which the
livedo is present at birth or soon after. There may be other
congenital
abnormalities including neurological and intellectual
problems, and it can
be familial. The livedo is usually severe but may improve
with age.
Idiopathic livedo reticularis (i.e. cause unknown) occurs
most commonly in
young and middle-aged females, particularly during winter.
Mottling occurs
first only on exposure to cold but can become permanent.
Tingling and
numbness on cold exposure are common. Sometimes swelling,
and rarely ulcers
may develop in winter. In another less common variant,
swelling of the feet
and ankles and ulceration occurs in the spring and summer
months.
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Most patients also experience inner ear pain or a feeling of
fullness (pressure) in the ears. This pressure in the ears can best
be described as
the feeling one normally gets when descending in an airplane.
Hyperacusis can be devastating to the patient's career,
relationships, and peace of mind. Finding the proper diagnosis is
difficult because few doctors
understand hyperacusis.
A LIFE ALTERING CONDITION
Hyperacusis makes living in this noisy world difficult and
dramatically changes the patient's pattern of life. Moving about,
traveling, and communicating with others is challenging. Ear
protection must be worn in
areas that seem too loud. This includes earplugs, industrial
earmuffs or both if necessary.
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