Livedo Reticularis is a common dermatological finding. It is a vascular condition. It appears as a lace like purplish reticular pattern on the skin. It is usually seen on the lower extremities, and may be exacerbated be cold exposure. It is probably caused due to swelling of the medium sized veins in the lower extremities. It may be a normal finding or may be associated with diseases associated with the blood, endocrine system, cardiovascular and autoimmune disorders like lupus, antiphospholipid syndrome or Sneddon’s syndrome. In cases where it occurs as a normal phenomenon, it causes no symptoms and requires no treatment. In some cases however; this condition may be associated with pain, discomfort and ulcer formation on the skin affected. In such cases further evaluation, diagnosis of the underlying disorder and treatment will be required. Livedo Reticularis may occur as a result of side effects of certain drugs such as hydroxyurea.
Causes: A number of conditions may be associated with the appearance of this condition. A few of them are mentioned below:
Sneddon’s syndrome: it is a genetic condition. It is associated with livediod vasculitis and systemic vascular disorders like cerebrovascular accidents commonly known as strokes and hypertension. It is a progressive, non inflammatory arteriopathy leading to skin problems as well as cerebrovascular accidents like transient ischaemic attacks, dementia and stroke.
Cutis marmorata telangiectatica congenita: It is a rare congenital vascular disorder affecting the blood vessels of the skin. Females are more affected than males, and usually observed at birth or shortly thereafter.
Idiopathic livedo reticularis: this is the most common form seen. Idiopathic simply means that the cause is unknown. It is a benign condition and commonly affects females more than males. It is known to worsen in cold climatic conditions and gives rise to a lacy purplish appearance of the skin on the extremities. This is caused due to sluggish blood flow in the veins of the extremities. It is usually asymptomatic. However, in a few cases patients may develop ulceration over the affected skin of the lower extremities. Warm protective clothing and warm applications on the affected area, may improve the condition.
Secondary Livedo Reticularis: Autoimmune disorders affecting the vascular system like: Livediod vasculitis, polyarteritis nodosa, systemic lupus erythematosus, rheumatoid arthritis and dermatomyositis.
Drugs that can cause Livedo Reticularis are amantidine, hydroxyurea etc.
Infections like tuberculosis, syphilis and lyme’s disease also may be associated.
Certain other conditions like Antiphospholipid syndrome it a condition that affects coagulation of blood and causes formation of small blood clots in the arteries and veings.
Hypercalcaemia- which means high blood calcium levels that may get deposited,
Cryoglobulinaemia is a condition in which the blood contains large amounts of cryoglobulins which is a protein that is insoluble at low temperatures.
Arteriosclerosis means thickening and sclerosis of the walls of the arteries.
Polycythaemia rubra vera or thrombocytosis increase the risk of forming thrombi in the blood.
Treatment: Idiopathic Livedo reticularis does not require any treatment. It may improve on warm covering and warm applications to the affected parts. Once established however the discolouration may becomes permanent. When secondary causes are involved, the causes must be identified and treated.
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