LIVEDO RETICULARIS

By Gary M. White, MD

Livedo reticularis Photo courtesy University of California, San Diego, Dept of Dermatology


Livedo reticularis is the a pattern of reticular erythema usually of the legs that is a manifestation of vascular obstructive disease. It is a sign, not a specific disease, and workup for a cause should be performed.

Clinical

A reticulated, vascular, blanching, dusky redness of the legs occurs as a cutaneous sign of underlying vascular obstructive disease in livedo reticularis (LR). In severe cases, it may appear on the trunk and arms. It is also a common clinical sign in patients in shock.

Workup

The general workup can include:

Causes of Livedo Reticularis

Antiphospholipid Antibody Syndrome

Coumadin Livedo Reticularis may develop soon after initiation of Coumadin therapy. Purple toes may also be seen and the common mechanism seems to be cholesterol embolization. [Am J Med 1987;82;1233]

Cryoglobulins. Mixed cryoglobulinemia syndrome can lead to LR, purpura, ulcerations, urticaria, arthralgias, and weakness.

Dermatomyositis

Embolic Phenomenon, e.g., Cholesterol Emboli or Hydrophilic Polymer Emboli

Lucio's Phenomenon. A severe necrotizing reaction of diffuse lepromatous leprosy characterized by livedo reticularis, ulcers, and other signs of vasculitis.

Lupus Erythematosus. [AD 1987;123;596]

Medications, e.g., amantadine

Oxalosis

Parvovirus B19 Infection. A 29-year-old woman was reported to have developed fever, chills, generalized and increasing muscular weakness and extensive livedo reticularis. Serologic testing showed recent Parvovirus B19 infection. The livedo cleared within 3 days with antipyretics and bed rest. [AD 1995;131;744]

Pheochromocytoma

Polyarteritis Nodosa. Palpable purpura, punched-out ulcers, nodules, and livedo reticularis may occur in polyarteritis nodosa.

Polycythemia Rubra Vera. [JAAD 1992;26;264]

Rheumatoid Vasculitis. [AD 1999;135;649]

Quinidine. Livedo reticularis 24-48 hours after sun exposure in a patient on quinidine may occur. [AD 1989;125;417 and JAAD 1985;12;332]

Sneddon's Syndrome

Shock. See NEJM image.

Additional Pictures

Livedo reticularis

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