Livedo reticularis

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Livedo reticularis
Livedo reticularis secondary to obscure severe infrarenal aortoiliac stenosis with transient lactic acidosis.
SymptomsPurpura, mottling of the skin, blood clots, skin discoloration
CausesAutoimmune diseases, hyperlipidemia, poisons, drug abuse

Livedo reticularis is a skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin.[1][2] The discoloration is caused by reduction in blood flow through the arterioles that supply the cutaneous capillaries, resulting in deoxygenated blood showing as blue discoloration. This can be a secondary effect of a condition that increases a person's risk of forming blood clots, including a wide array of pathological and nonpathological conditions. Examples include hyperlipidemia, microvascular hematological or anemia states, nutritional deficiencies, hyper- and autoimmune diseases, and drugs/toxins.

The condition may be normal or related to more severe underlying pathology.[3] Its differential diagnosis is broadly divided into possible blood diseases, autoimmune (rheumatologic) diseases, cardiovascular diseases, cancers, and endocrine disorders. It can usually (in 80% of cases) be diagnosed by biopsy.[4]

It may be aggravated by exposure to cold, and occurs most often in the lower extremities.[5]

The condition's name derives from the Latin livere which means bluish, and reticular which refers to the net-like pattern.[6]

Signs and symptoms


A number of conditions may cause the appearance of livedo reticularis:


Livedo reticularis is diagnosed by its clinical appearance and history. No further test or examination confirms idiopathic livedo reticularis, however, further investigations may be undertaken where an underlying cause is suspected such as skin biopsies, or blood tests for antibodies associated with antiphospholipid syndrome or systemic lupus erythematosus.[47]


Other than identifying and treating any underlying conditions in secondary livedo,[48] idiopathic livedo reticularis may improve with warming the area.

See also


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  2. Wakelin, Sarah H. (2020). "22. Dermatology". In Feather, Adam; Randall, David; Waterhouse, Mona (eds.). Kumar and Clark's Clinical Medicine (10th ed.). Elsevier. p. 682. ISBN 978-0-7020-7870-5. Archived from the original on 2021-12-11. Retrieved 2021-12-11.
  3. "livedo reticularis" at Dorland's Medical Dictionary
  4. Kroshinsky; Stone, John H.; Bloch, Donald B.; Sepehr, Alireza (February 2009). "Case 5-2009 — A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs". New England Journal of Medicine. 360 (7): 711–20. doi:10.1056/NEJMcpc0807822. PMID 19213685.
  5. James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "35.Cutaneous vascular diseases". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 817. ISBN 978-0-323-54753-6. Archived from the original on 2023-03-18. Retrieved 2023-03-18.
  6. Sundriyal, Deepak; Kumar, Naveen; Kumar, Gaurav; Walia, Meenu (15 May 2014). "Livedo reticularis heralding hypercalcaemia of malignancy". BMJ Case Reports. 2014: bcr2013201371. doi:10.1136/bcr-2013-201371. PMC 4024535. PMID 24832704.
  7. Sneddon IB (April 1965). "Cerebro-Vascular Lesions And Livedo Reticularis". British Journal of Dermatology. 77 (4): 180–5. doi:10.1111/j.1365-2133.1965.tb14628.x. PMID 14278790. S2CID 43219068.
  8. Gibbs, Mark B.; English, Joseph C.; Zirwas, Matthew J. (2005). "Livedo reticularis: an update". J Am Acad Dermatol. 52 (6): 1009–19. doi:10.1016/j.jaad.2004.11.051. PMID 15928620.
  9. Feldaker M, Hines E, Kierland R (1955). "Livedo reticularis with summer ulcerations". AMA Arch Dermatol. 72 (1): 31–42. doi:10.1001/archderm.1955.03730310033007. PMID 14387292.
  10. Golden R (March 1963). "Livedo reticularis in systemic lupus erythematosus". Arch Dermatol. 87 (3): 299–301. doi:10.1001/archderm.1963.01590150015002. PMID 13948706.
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  15. Cruz, Boris Afonso; de Queiroz, Eustáquio; Nunes, Simone Vilela; Cruz Filho, Achiles; Campos, Gilberto Belisario; de Carvalho Monteiro, Ernesto Lentz; Crivellari, Humberto (2000). "Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso" [Severe Raynaud's phenomenon associated with interferon-beta therapy for multiple sclerosis: case report]. Arquivos de Neuro-Psiquiatria (in português). 58 (2B): 556–9. doi:10.1590/S0004-282X2000000300025. PMID 10920422.
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