Livedo reticularis I73.83

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 09.04.2021

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Synonym(s)

Cutis marorata; livedo anularis

Definition
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Harmless, functional, temperature-dependent (hypothermia) disturbance of the dermal blood supply with flow slowing and hypoxygenation of the blood of the affected region and livid network drawing of the skin. In contrast to the non-functional, but organically caused livedo racemosa, the reticulation consists of closed rings with a diameter of 2.0-3.0 cm. The red border zones do not correspond to shimmering vessels but mark the zones with low oxygenated blood. The feeding vessel of this skin compartment is located in the centre of the ring (see figure with schematic drawing).

In livedo racemosa, on the other hand, vascular occlusion with irregular focal circulation disturbance occurs, which leads to bizarre "lightning-figure" erythema patterns on the skin.

Etiopathogenesis
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Mostly functional, harmless dysregulation after exposure to cold (Livedo reticularis e frigore; Cutis marmorata) occurring and disappearing again after warming.

Less frequently after heat exposure ( erythema e calore).

Furthermore with:

  • disorders of blood viscosity (polyglobulia, cryoglobulinemia; paraporteinemia)
  • central innervation disorders (apoplexy, trauma)
  • for infections (e.g. hepatitis C, tuberculosis)
  • in case of drug exposure (e.g. heparin, erythromycin, amantadine, interferons)
  • after carbon dioxide arteriography
  • at various neoplasia (e.g. renal cell carcinoma).

Manifestation
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Occurs regularly in infants in the first weeks of life when the skin cools slightly.

In adolescents and young (mostly female) adults as a harmless, functional disturbance of the blood circulation.

A livedo reticularis occurring beyond the neonatal period may be a sign of trisomy 18, Down syndrome, the rare Cornelia de Lange syndrome or hypothyroidism.

Localization
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Symmetrical at the extremities, possibly also at the trunk.

Clinical features
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Large-mesh livid marbling, depending on the shape disappearing or appearing after heating or cooling. Frequently peripheral flat acrocyanosis which dissolves proximally into the livid ring structures of the livedo reticularis.

Histology
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Only gradual changes to normal findings. Gfls. dilatation of the postcapillary venules of the superficial and deep vascular plexus. No vascular occlusion (DD Livedo racemosa).

Differential diagnosis
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Livedo racemosa (see also Abbot);

Acrocyanosis

Therapy
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Roborative measures such as alternating warm baths, sauna, dry brushing, etc..

Progression/forecast
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Improvement with age.

Literature
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  1. Gibbs MB et al (2005) Livedo reticularis: an update. J Am Acad Dermatol 52: 1009-1019
  2. Endo Y et al (2011) Idiopathic livedo reticularis concomitant with polyclonal IgM hypergammopathy. Eur J Dermatol 21:266-267
  3. Fox M et al (2012) Livedo reticularis: a side effect of interferon therapy in a pediatric patient with melanoma. Pediatric Dermatol 29:333-335
  4. Ruiz-Genao DP (2005) Livedo reticularis associated with interferon alpha therapy in two melanoma patients. J Eur Acad Dermatol Venereol 19: 252-254
  5. Sladden MJ et al (2003) Livedo reticularis induced by amantadine. Br J Dermatol 149: 656-658
  6. Zelger B et al (1995) Differential diagnosis of livedo syndromes. dermatologist 46: 369-379

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 09.04.2021