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.
Sneddon's syndrome is a form of idiopathic livedo
reticularis with systemic involvement i.e. internal blood
vessels are affected, most commonly in the brain, eye and
heart.
*Source
http://www.dermnetnz.org/vascular/livedo-vascularis.html
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Secondary livedo reticularis is of known cause. It may be
a sign of vasculitis (inflammation of the blood vessels) or of
obstruction of the vessel by some circulating material. The
following conditions may be
responsible:
-Vasculitis
-Livedoid vasculitis
-Polyarteritis nodosa
-Systemic lupus erythematosus
-Dermatomyositis
-Rheumatoid arthritis
-Lymphoma
-Pancreatitis
-Tuberculosis
-Obstruction
-Cryoglobulinaemia (immune globulins that precipitate in the cold)
-Antiphospholipid syndrome (blood clots due to sticky platelets) or
lupus
-anticoagulant syndrome
-Hypercalcaemia (calcium deposits)
-Polycythaemia rubra vera (excessive number of red cells) or
thrombocythaemia (platelet clumps)
-Infections (syphilis and tuberculosis)
-Arteriosclerosis (cholesterol emboli) and homocystinuria
-Intra-arterial injection (especially in drug addicts)
What treatments are available?
There is no treatment for livedo reticularis. Rewarming the area in
idiopathic cases or treatment of the underlying cause of secondary
livedo may reverse the discoloration. However, over time the vessels
become permanently dilated and livedo reticularis becomes permanent
regardless of the surrounding temperature.
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