Livedo Reticularis - Causes and Symptoms

Definition

The livedo reticularis is a cutaneous manifestation characterized by a mottled discoloration, in which cyanotic patches of blue-reddish coloration take on a network-like conformation around normal skin areas.

See Photo Livedo Reticularis

This symptom is observed mainly in the lower limbs, but can also extend to the arms and trunk. Usually, the livedo reticular is more pronounced in the cold season, due to exposure to low temperatures. In this case, this manifestation is temporary and is resolved by removing the trigger element.

Sometimes, however, the livedo reticularis tends to be more intense and persistent, due to the presence of factors that cause the alteration of the blood flow and the stasis of deoxygenated blood in the small blood vessels at skin level. This may signal the presence of a more serious underlying pathology, such as essential thrombocythemia or anti-phospholipid antibody syndrome (APS).

Conditions associated with livedo reticularis include hematologic and cardiovascular disorders, autoimmune diseases, tumors and endocrine disorders.

Causes include nutritional deficiencies, hyperlipidemia, inflammation of blood vessels (polyarteritis nodosa and other vasculitis), systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, lymphoma and pancreatitis.

Livedo reticularis can also be induced by certain drugs as a side effect.

This manifestation may also depend on hypercalcemia, cryoglobulinemia, polycythemia vera or thrombocytosis, infections (syphilis, tuberculosis, cytomegalovirus and Lyme disease), pernicious anemia, arteriosclerosis, homocystinuria and acute renal failure.

Livedo reticularis can also be found in the presence of pheochromocytoma, sarcoidosis, Sjögren's syndrome and Buerger's disease. Rarely, this symptom can be observed in case of mammary metastatic carcinoma, renal cell carcinoma, hyperthyroidism and Ehlers-Danlos syndrome, Down and Churg-Strauss syndrome.