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Key Features

Livedo reticularis

  • A benign condition that primarily affects the extremities

  • Usually asymptomatic (apart from cosmetic concerns)

  • Produces a mottled, purplish discoloration of the skin in a fishnet pattern with reticulated cyanotic areas surrounding paler central cores

Livedo racemosa

  • Formerly known as secondary livedo reticularis

  • Occurs in association with various diseases that cause vascular obstruction or inflammation

Clinical Findings

Livedo reticularis

  • Spasm or obstruction of perpendicular arterioles combined with pooling of blood in surrounding venous plexuses

  • Worsens with cold exposure

  • Improves with warming

  • Consider an underlying disease when

    • Systemic symptoms are present

    • Cutaneous ulcerations develop

Livedo racemosa

  • Resembles idiopathic livedo reticularis

  • Has a wider distribution (often found on trunk and buttocks as well as extremities)

  • Lesions are more irregular, broken, and circular

  • Presenting manifestation of 25% of patients with antiphospholipid antibody syndrome

  • Other underlying causes include

    • Sneddon syndrome (livedo reticularis and cerebrovascular events)

    • Vasculitides (particularly polyarteritis nodosa)

    • Cholesterol emboli syndrome

    • Thrombocythemia

    • Cryoglobulinemia

    • Cold agglutinin disease

    • Primary hyperoxaluria (due to vascular deposits of calcium oxalate)

    • Disseminated intravascular coagulation

Diagnosis

  • Clinical

Treatment

  • Protection from exposure to cold

  • Vasodilators seldom indicated

  • If ulcerations or gangrene, exclude an underlying systemic disease

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