What you should know about Livedo reticularis

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Livedo reticularis is a special type of skin discoloration that consists of a reddish-purple cobweb-like pattern that forms circles, usually on the legs or arms. Livedo reticularis is a common (and temporary) occurrence in babies and young women exposed to cold temperatures and is completely harmless in these cases. However, it can also be seen in a number of serious medical conditions.

If livedo reticularis occurs outside of its typical benign pattern, this may be the first sign that a full medical examination is needed.

Laura Porter / Get Medication Information

Causes

Livedo reticularis is generally divided into two categories: physiological and pathological.

Physiological Livedo reticularis

Physiological reticular livedo is a common occurrence in people who do not have an underlying medical condition and is generally considered a variant of normal.

In people who have physiological livedo reticularis, exposure to cold causes some arterioles (small arteries) that supply the skin to narrow, reducing the blood supply to the skin. The center of the area of skin supplied by this narrow artery turns pale, and the blood trapped in the small blood vessels around the area supplied by this arteriole turns purple (because it is deoxygenated). The result is a purple fading circular weave pattern with a faint center.

Since many arterioles narrow at low temperatures, livedo reticularis usually forms a large network of these circular patches. When the skin is heated, the narrow arterioles open and livedo reticularis disappears.

Reticular physiologic disease is considered normal and is seen most often in infants and young and middle-aged women.

Pathological Livedo reticularis

Abnormal livedo reticularis (sometimes called livedo racemosa) is also caused by blockage of the penetrating arterioles that supply skin tissue. But here the blockage is caused by something other than physiological narrowing of the blood vessels, and depending on the underlying cause, the rash may be permanent rather than transitory.

There are many conditions that can lead to abnormal reticular livedo, including:

Symptoms

Physiological Livedo reticularis: a noticeable change in skin color is the only symptom. It consists of a reddish purple discoloration with a fine reticular structure (like a cobweb) that forms numerous circular patterns on the surface of the skin.

Livedo reticularis is most commonly found on the arms and legs. Round formations tend to be complete, with some broken segments. The centers of these circles are usually quite pale. The discoloration is completely "flat", which means it has no bumps or bumps. It doesn't hurt. It's just a color change.

Reticular physiological disease appears temporarily when a person is exposed to cold and disappears when the skin is heated.

Abnormal reticular lido: Symptoms may be identical to those seen with physiologic reticular lido. However, when livedo reticularis is caused by a serious underlying medical problem, the pattern of discoloration is usually atypical.

In abnormal livedo reticularis, the affected skin color is usually bright purple and is likely to form a very irregular pattern of broken circles rather than full, regular circles. Skin changes also tend to be more generalized and, in addition to the arms and legs, they usually appear on the trunk and buttocks and can even be generalized . There may be a nodule or ulcer in the center of the circular patterns, in which case severe pain may occur. The skin discoloration in livedo reticularis tends to be permanent rather than just temporary, and is often subtly associated with low temperatures.

Given the wide range of conditions that can cause abnormal reticular fluid, this phenomenon often occurs in conjunction with any of the symptoms associated with the underlying cause.

Diagnostics

The diagnosis of livedo reticularis is usually straightforward given the characteristic appearance of the phenomenon and the typical circumstances in which it occurs. In the vast majority of cases, livedo reticularis is normal and no further investigation is required.

Diagnosis can be difficult if the change in skin color or the circumstances in which it appears indicate a non-physiological cause, that is, if the condition appears to be pathological. In these cases, the doctor must begin with a complete medical history and physical examination to find a clue to one of the many medical problems that can cause this phenomenon. When such clues are found, specific diagnostic tests must be performed to find the putative diagnosis.

If the initial evaluation does not have a clear direction, the doctor usually begins with blood tests: a complete blood count and a metabolic panel . Blood tests may also be done to detect cold agglutinins, antiphospholipids, cryoglobulins, cryofibrinogens, autoimmune diseases, and blood clotting disorders. A CT scan or MRI may also be done if cancer is suspected. A skin biopsy can also help diagnose the underlying cause.

These screening tests usually point in the right direction when there is an abnormal livedo reticularis.

Watch out

Reticular physiological disease is a normal and transient event with no known medical consequences. Other than heating the skin, no treatment is required.

Since the underlying medical problems associated with abnormal reticularis are often serious and life-threatening, once a correct diagnosis is made, treatment should be aimed at eliminating or improving this underlying cause.

Get the word of drug information

Livedo reticularis is usually a common, benign, and transient skin discoloration associated with exposure of the normal circulatory system to cold. However, in some cases, livedo reticularis is caused by a serious underlying medical problem. The nature of the discoloration and the circumstances under which it occurs should give the physician important clues as to whether livedo reticularis requires a complete physical examination or just confirmation.

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