Livedo Reticularis & Livedo Racemosa

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 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 skin distribution (including trunk, buttocks, and extremities)

• Lesions are more irregular, broken, and circular

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

• Other underlying causes include

  • Antiphospholipid antibody positive 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