Livedo (overview) I73.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Polyätiological, monitoring phenomenon of the skin characterized by a red or red-blue, reticular discoloration of the skin.

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Basically can be divided into:

S.a.u. livedo syndromes.

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Pathogenetically, this phenomenon is based on a functionally or organically caused disturbance of the blood circulation. The resulting slowing down of the blood flow leads to an increased oxygen depletion and thus to a reduced oxygenation of the blood. The blue-reddish, cyanotic network structures do not correspond to vessels that shimmer through, but to zones with reduced oxygenated blood. This is particularly noticeable on thin and light skin. The phenomenon disappears with the appearance of oedema or dermatosclerosis. The circular basic element of liveo drawing is explained by the anatomy of the blood supply. End arteries supply the skin in vertical section in a sector-shaped manner, in a circular manner when viewed from above. The oxygen supply is highest in the centre of the circle, lowest in the periphery.

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In principle, a distinction must be made between:

  • the harmless livedo reticularis, which is based on a vasomotor dysfunction and which occurs when the skin cools below a critical cold point and is completely reversible when rewarmed. Symmetrical, evenly closed rings are found which join together as a uniform reticular macro pattern.
  • The second livedo form is the livedo racemosa. It differs from the livedo reticularis by its strict constancy of location; further by asymmetry and lack of dependence on cold, and as an easy to judge morphological phenomenon, by the bizarre only hinted at ring formations, which are again and again sharply interrupted and give off a strange "inorganic" pattern. This is due to local flow interruptions which cause an abrupt change in the local blood flow. It is irrelevant whether the flow obstruction is in the venous or arterial leg.
  • The causes are manifold and have to be clarified. Aggravated cholsterol embolism (in arteriosclerosis) or foreign materials (e.g. incorrectly injected filler materials), fibrin thrombi, immune complexes in monoclonal gammopathies or various other causes. Infectious diseases (Note: the first description of livedo racemosa was made in 1907 by the Viennese syphilis expert Ehrmann for syphilis), in intimate proliferation processes, or in vasculitic processes.
  • Remark: Unfortunately, in the international literature this necessary distinction is not made, so that it is not always clear which form of livedo is actually meant. This leads in international literature to a nomenclatural confusion of languages that is difficult to understand.

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  1. Fritsch P (1998) Dermatology and Venereology, Textbook and Atlas. Springer, Berlin Heidelberg New York, S. 507-508


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Last updated on: 29.10.2020