Livedo Reticularis

What is livedo reticularis?

Livedo reticularis is the medical condition in which blotchy skin discoloration occurs due to capillary blood vessels dilated and blood circulation become stagnant. Livedo reticularis term refers due to the specific type of skin discoloration is noticeable in which the central part is pale surrounded by reddish blue (cyanotic) reticular discoloration.

The symptoms are mostly observable in the upper and lower limbs and trunks during winter season. This condition develops due to blood circulation is impaired.

Evidence shows livedo reticularis is associated with systemic lupus erythematosus, which is an autoimmune disease; where faulty antibiotic production means phospholipid containing antibodies are produced and causes brain strokes.

Symptoms

Livedo reticularis can be developed at any age. The usual affected sites are the arms, legs, trunk and rarely it also observable on the back. Following are the symptoms of livedo reticularis:

Purple or bluish red discoloration on the skin surface
Pale coloration at the central of the discolored area.
The discoloration is not even; it is mottled
Pain is associated in some cases
Skin ulceration may develop which produce discomfort and pain; this is more prominent in lower limbs
Numbness
Increase of body temperature
Inning or burning sensation
‘Falling asleep’ condition may develop at the upper or lower limbs
The condition becomes worsen with chilled temperature

Causes

The prime cause of the Livedo reticularis is an impairment of the blood flow through the arterioles and the networking junction (capillaries). The cyanosis is the result of underlying disease condition which causes inflammation of the venules. The different possible associated conditions responsible for development of the Livedo reticularis are as follows:

Sneddon syndrome

This condition is associated with cerebrovascular disorder and possible cause of this condition is some inherent factors which lead to cause systemic vascular diseases, including strokes.

Cutis marmorata telangiectatica congenital

This is a rare intermittent congenital vascular abnormality. This affects the blood vessels present under the skin surface.

Idiopathic livedo reticularis

This condition is more common in female teenagers. This leads to uneven blood circulation through the veins. The direct exposure to heat causes ulceration on the thigh, buttocks, abdominal area and breasts.

Polyarteritis nodosa

This is an autoimmune disease which damages the arterioles and leads to vasculitis.

Fibromyalgia

This condition is associated with musculoskeletal disorder, in chronic condition this leads to Livedo reticularis.

Livedoid vasculopathy

This is mainly affects lower limbs and causes pain and skin ulceration without any inflammation.

Dermatomyositis

This may affects at any age. Distinct skin rashes, muscle weakness and inflammation are the main features of this condition. This condition is also attributed inflammation of the blood vessels and leads to Livedo reticularis.

Lymphoma

The cancerous development of the lymphocytes is often causes Livedo reticularis.

Antiphospholipid syndrome

In this condition the formation of antiphospholipid antibodies causes excessive blood coagulation which seems as cyanosis, discoloration of the skin. It also causes decreases the number value of platelets. This creates complications in pregnancy.

Homocystinuria

In this condition calcium level is decreases because of impaired metabolism of the amino acid methionine and causes blood coagulation disorder.

Arteriosclerosis/Cholesterol emboli

This leads to hardening and thickening of the arterial walls due to blood vessels walls are dilated.

Ehlers-Danlos Syndrome

The major symptoms of this condition like spotty discoloration on the skin and others are similar with Livedo reticularis and also this condition causes hypermobility of the joint.

Systemic Lupus Erythematosus

In case of lupus patient, reticulated spotted discoloration due vascular disorder is quite common. The ripple of the arterioles present just beneath the skin surface is common feature of this condition.

Autonomic nerve impairment

Physical injury may causes autonomic nerve impairment and leads to abnormal blood circulation through arterioles, veinules and capillaries which causes Livedo reticularis.

Hypercalcaemia

Increase blood calcium level can decrease the blood circulation and leads to Livedo reticularis.

Following are the other risk factors; presence of this may increase the chances of Livedo reticularis:

Tuberculosis
Pancreatitis
Thrombocytosis
Rheumatoid arthritis
Graves’s disease
Renal failure
Sexually transmitted diseases
Diabetes
Polycethaemia
Routine alcohol consumption
Down’s Syndrome

Differential Diagnosis

Different underlying conditions such as retiform purpura, subcutaneous nodules, secondary ulceration and necrosis cause a more prominent vascular effect. The proper diagnosis measures assist to determine the medical history or any other causes which include drug effects can lead to Livedo reticularis. Following differential diagnosis may helpful for determining the condition:

Heart or vascular problems
Blood disorders
Autoimmunity
Malignancy
Hormonal imbalance

Following blood tests are usually conducted:

Complete blood count
Antineutrophil cytoplasmic antibodies
Antinuclear antibodies
Cryoglobulins
To leave out the possibility of malignancy, skin sample is taken out from the discoloured part of the skin and biopsy test is conducted.

Treatment

Depending upon the diagnostic test result, treatment of Livedo reticularis depends. The aim of the treatment is to treat the underlying cause. In case of asymptomatic condition need not to treat, it will be lessened by own with time.

Sometimes hot compression also helps to reduce pain and discomfort.
The side effect of the drug can be lessened by withdrawing the drug.
The networking like discolored patches will remain in case of delayed treatment. Dermatological treatment cannot treat the condition, if under lying cause is not treat properly. Even delayed treatment also causes complications which include thrombohemorrhagic and Thrombocytosis disorder.
Blood thinning drugs like aspirin at low dose and hydroxychloroquine are prescribed in case of antiphopholipids.
In case of cryoglobulinaemia, plasmapheresis could be carried out.
For curing polyarteritis nodosa, immunosuppressive drugs like cyclophosphamide and azathiprine can be prescribed.
Steroidal drugs or other inflammation reducing drugs are prescribed for dermatomyositis.
Phenformin and pentoxifylline are act as anticoagulants and anti- platelet agents for treating the Livedoid vasculopathy.
If cardiac problem initiate the Livedo reticularis, then doctors prescribe cardiovascular drugs like ACE inhibitors, beta-blockers, cholesterol lowering drugs.
For controlling the recurrence the incidence, it is advisable to avoid cold weather or arduous exercises.

Pictures