Livedo reticularis

Livedo reticularis Definition

It is a dermatological disorder marked by a mottled purplish discoloration of the skin due to stagnation of blood within the capillaries and venules. It is a normal condition that occurs more often during winter. The term has been derived from the Latin word “livere” meaning bluish and “reticular”, referring to net-like appearance.

Livedo reticularis Symptoms

Livedo reticularis

It could affect both adults and babies. The vascular disorder occurs on the legs, arms, trunk, and rarely on the back. Medical experts describe the condition as a reticular cyanotic cutaneous discoloration surrounding pale central regions with no signs of blanching. Some patients may complain of pain and discomfort in the lower extremities followed by development of skin ulcers. Numbness, fever, paresthesias, hand/foot drop and weakness are some of the other clinical features of the condition. In most cases, the ailment produces no symptoms, but may get aggravated when exposed to extreme cold.

Causes of Livedo reticularis

The lacy appearance is plainly a result of an impaired blood circulation caused by thrombosis in capillaries and arterioles. The reddish blue discoloration is associated with several underlying pathological conditions that cause swelling of the venules. These include:

Sneddon syndrome

It is a non-inflammatory arteriopathy in which the mottled discoloration of the skin has a relation with cerebrovascular disease. In this condition, some hereditary factors can lead to systemic vascular diseases, including strokes.

Cutis marmorata telangiectatica congenital

This uncommon, sporadic congenital vascular anomaly often affects the blood vessels of the skin.

Idiopathic livedo reticularis

Unsteady flow of blood through the veins, particularly in young females, could occur for unknown reasons. However, the sudden network-patterned cutaneous discoloration is completely innocuous with mild episodes of ulceration on the breasts, abdomen, buttocks and thigh, caused by heat.

Polyarteritis nodosa

Self-destructive immune cells often attack the medium and small-sized arteries, resulting in a severe type of vasculitis.

Fibromyalgia

The lacy discoloration of the skin can also be attributed to fibromyalgia, a chronic disorder marked by musculoskeletal pain, fatigue and tenderness.

Livedoid vasculopathy

It is a chronic, recurrent, painful skin disorder that involves lower extremities and feet. The thrombotic condition is non-inflammatory in nature and oftentimes leads to ulceration in the legs.

Dermatomyositis

In adults and young children, this inflammatory disorder manifests into muscle weakness and a distinctive skin rash. Swelling of the blood vessels may give rise to a reticular cyanotic discoloration of the skin.

Lymphoma

The vascular disease is often a common sign of blood cancer of the white blood cells.

Antiphospholipid syndrome

It is a complicated condition in which the presence of antiphospholipid antibodies in the blood leads to excessive clotting and low platelet count. Formation of such clots may either cause brushing or a blotchy, purplish rash. The disorder has often been linked to morbidity in pregnancy.

Cryoglobulinaemia

The stagnation of blood in the arteries and venules is frequently caused by precipitation of cryoglobulins at low temperatures.

Homocystinuria

It is an impaired metabolism of the amino acid methionine, which results in deficiency of calcium in the body.

Arteriosclerosis/Cholesterol emboli

Dilation of capillaries and venules could also be associated with thickening and hardening of the arterial walls.

Ehlers-Danlos Syndrome

It encompasses a group of disorders in which mottled cutaneous discoloration, laxity and joint hypermobility are the common hallmarks of the syndrome.

Systemic lupus erythematosus

The mottled reticulated vascular pattern is common in lupus patients since it causes spasm of the dermal ascending arterioles.

Autonomic nerve damage

Physical trauma or injury may lead to autonomic neuropathy in some cases. One of the most common manifestations of this condition is the abnormal rate of blood flow through the small arteries and capillaries that results in a bluish, lace-like discoloration of the skin. Palmar erythema, a vascular disease of the palms, has a similar cause.

Hypercalcaemia

Elevated levels of blood calcium can reduce the flow of blood through the narrow capillaries and veins.

Some of the other possible causes of the disorder are mentioned below:

  • Thrombocytosis
  • Polycythaemia rubra vera
  • Syphilis
  • Tuberculosis
  • Lyme disease
  • Acute kidney failure
  • Use of intravenous drugs and birth control pills
  • Pancreatitis
  • Intake of amantadine
  • Regular consumption of alcohol
  • Tuberculosis
  • Graves’s disease
  • Rheumatoid arthritis
  • Adderall
  • Diabetes
  • Down’s syndrome

Livedo reticularis Diagnosis

Associated conditions such as subcutaneous nodules, retiform purpura, necrosis and secondary ulceration makes the vascular condition more prominent. Proper diagnostic information can be obtained from a detailed history that should include regularly consumed drugs and primary disorders. Differential diagnosis is essential as it helps in placing the non-blanchable disorder under the following groups:

  • Autoimmune disorders
  • Hematological conditions
  • Cardiac problems
  • Endocrine diseases
  • Cancers

A simple blood test may aid in the evaluation of complete blood count, antinuclear antibodies, antineutrophil cytoplasmic antibodies, and cryoglobulins. A skin biopsy can be taken from the purplish discolored region to exclude the possibility of cancer.

Livedo reticularis Treatment

Appropriate medical care can be initiated to the affected patients on the basis of the results acquired from the diagnostic tests and exams. The etiology of the condition is instrumental for treatment. Idiopathic livedo reticularis is a self-limiting condition that could be controlled by keeping the legs warm with the aid of a heating pad. Asymptomatic form of the disorder may come and go without the knowledge of the patients. Drug-induced livedo reticularis requires immediate withdrawal in order to reduce the attacks. However, the net-like purplish discoloration of the skin could become a permanent problem if not treated in time. The dermatologic manifestation is itself not treatable unless doctors recognize the underlying disorders. Delayed treatment may cause complications like thrombocytosis and thrombohemorrhagic disorder. Patients with antiphopholipids can be administered low-dose aspirin and hydroxychloroquine. Plasmapheresis could be carried out for cryoglobulinaemia. Immunosuppressive drugs such as cyclophosphamide and azathiprine can be used to cure polyarteritis nodosa. Livedoid vasculopathy-affected individuals may receive anti-platelet agents, anticoagulants, pentoxifylline and phenformin. On the other hand, anti-inflammatory medications like corticosteroids are suitable for treating dermatomyositis. Healthcare professionals prescribe cholesterol drugs, beta-blockers, and ACE inhibitors for lowering blood pressure and controlling the heart rate. The frequent episodes of the cutaneous condition can be prevented by avoiding cold condition and strenuous exercises.

Images

Image of Livedo reticularis

 

Picture of Livedo reticularis

References

http://en.wikipedia.org/wiki/Livedo_reticularis

http://dermnetnz.org/vascular/livedo-reticularis.html

http://www.mayoclinic.com/health/livedo-reticularis/AN01622

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