Livedo reticularis

A number of conditions may cause the appearance of livedo reticularis:

• Cutis marmorata telangiectatica congenita, a rare congenital condition
• Sneddon syndrome – association of livedoid vasculitis and systemic vascular disorders, such as strokes, due to underlying genetic cause{{cite journal |vauthors = Sneddon IB|title=Cerebro-Vascular Lesions And Livedo Reticularis |journal=British Journal of Dermatology |volume=77 |issue=4 |pages=180–5 |date=April 1965 |pmid=14278790 |doi=10.1111/j.1365-2133.1965.tb14628.x|s2cid=43219068 }}
• Idiopathic livedo reticularis – the most common form of livedo reticularis, completely benign condition of unknown cause affecting mostly young women during the winter:{{cite journal |first1=Mark B. |last1=Gibbs |first2=Joseph C. |last2=English |first3=Matthew J. |last3=Zirwas |title=Livedo reticularis: an update |journal=J Am Acad Dermatol |volume=52 |issue=6 |pages=1009–19 |year=2005 |pmid=15928620 |doi=10.1016/j.jaad.2004.11.051}} It is a lacy purple appearance of skin in extremities due to sluggish venous blood flow. It may be mild, but ulceration may occur later in the summer.{{cite journal |vauthors=Feldaker M, Hines E, Kierland R |title=Livedo reticularis with summer ulcerations |journal=AMA Arch Dermatol |volume=72 |issue=1 |pages=31–42 |year=1955 |pmid=14387292 |doi=10.1001/archderm.1955.03730310033007}}
• Secondary livedo reticularis:
• Vasculitis autoimmune conditions:
• Livedoid vasculitis – with painful ulceration occurring in the lower legs
• Polyarteritis nodosa
• Systemic lupus erythematosus{{cite journal |author=Golden R |title=Livedo reticularis in systemic lupus erythematosus |journal=Arch Dermatol |volume=87 |issue= 3|pages=299–301 |date=March 1963 |pmid=13948706 |doi=10.1001/archderm.1963.01590150015002}}
• Dermatomyositis
• Rheumatoid arthritis
• Lymphoma
• Pancreatitis{{cite journal |vauthors=Sigmund W, Shelley W |title=Cutaneous manifestations of acute pancreatitis, with special reference to livedo reticularis |journal=N Engl J Med |volume=251 |issue=21 |pages=851–3 |year=1954 |pmid=13214346 |doi=10.1056/NEJM195411182512104}}
• Chronic pancreatitis{{cite journal |last1=Gould |first1=Jennifer W. |last2=Helms |first2=Stephen E. |last3=Schulz |first3=Susan M.| last4=Stevens |first4=Seth R. |year=1998 |title=Relapsing livedo reticularis in the setting of chronic pancreatitis |journal=Journal of the American Academy of Dermatology |volume=39 |issue=6 |pages=1035–1036 |pmid=9843029 |doi=10.1016/S0190-9622(98)70290-7}}
• Tuberculosis
• Drug-related:
• Adderall (side effect) {{Citation needed|date=February 2019}}
• Amantadine (side effect)
• Bromocriptine (side effect)
• Beta interferon treatment, e.g. in multiple sclerosis{{cite journal |last1=Rot |first1=Uroš |last2=Ledinek |first2=Alenka Horvat |date=December 2013 |title=Interferons beta have vasoconstrictive and procoagulant effects: a woman who developed livedo reticularis and Raynaud phenomenon in association with interferon beta treatment for multiple sclerosis |journal=Clinical Neurology and Neurosurgery |volume=115 |issue=Suppl 1 |pages=S79–81 |doi=10.1016/j.clineuro.2013.09.027 |pmid=24321162|s2cid=11757438 }}{{cite journal |last1=Fox |first1=Michelle |last2=Tahan |first2=Steven |last3=Kim |first3=Caroline C. |year=2012 |title=Livedo Reticularis: A Side Effect of Interferon Therapy in a Pediatric Patient with Melanoma |journal=Pediatric Dermatology |volume=29 |issue=3 |pages=333–5 |pmid=21575046 |doi=10.1111/j.1525-1470.2011.01426.x|s2cid=37285113 }}{{cite journal |last1=Cruz |first1=Boris Afonso |last2=de Queiroz |first2=Eustáquio |last3=Nunes |first3=Simone Vilela |last4=Cruz Filho |first4=Achiles |last5=Campos |first5=Gilberto Belisario |last6=de Carvalho Monteiro |first6=Ernesto Lentz |last7=Crivellari |first7=Humberto |title=Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso |trans-title=Severe Raynaud's phenomenon associated with interferon-beta therapy for multiple sclerosis: case report |language=pt |journal=Arquivos de Neuro-Psiquiatria |volume=58 |issue=2B |year=2000 |pages=556–9 |pmid=10920422 |doi=10.1590/S0004-282X2000000300025|doi-access=free }}
• Livedo reticularis associated with rasagiline{{cite journal |first1=Lindsay C. |last1=Strowd |first2=Andrew D. |last2=Lee |first3=Gil |last3=Yosipovitch |date=June 2012 |title=Livedo Reticularis Associated With Rasagiline (Azilect) |journal=Journal of Drugs in Dermatology |volume=11 |issue=6 |pages=764–5 |pmid=22648227 |url=http://jddonline.com/articles/dermatology/S1545961612P0764X |access-date=2014-03-21 |archive-date=2021-03-05 |archive-url=https://web.archive.org/web/20210305101135/https://jddonline.com/articles/dermatology/S1545961612P0764X |url-status=live }}
• Methylphenidate and dextroamphetamine-induced peripheral vasculopathy{{cite journal |doi=10.1097/RHU.0b013e3181639aaa|pmid=18431096|title=Methylphenidate and Dextroamphetamine-Induced Peripheral Vasculopathy|journal=Journal of Clinical Rheumatology|volume=14|issue=1|pages=30–33|year=2008|last1=Syed|first1=Reema H.|last2=Moore|first2=Terry L.}}
• Gefitinib{{cite journal |doi=10.1111/j.1365-4632.2007.03319.x|pmid=18173531|title=Livedo reticularis with retiform purpura associated with gefitinib (Iressa®)|journal=International Journal of Dermatology|volume=46|issue=12|pages=1307–8|year=2007|last1=Blume|first1=Jonathan E.|last2=Miller|first2=Craig C.|s2cid=43388374}}
• Obstruction of capillaries:
• Cryoglobulinaemia – proteins in the blood that clump together in cold conditions{{cite journal |vauthors=Langhof H, Braun G, Matzkowski H |title=Livedo reticularis durch Kältegelierung des Blutes bei γ-Plasmocytom |trans-title=Livedo reticularis due to cold gelation of the blood by gamma-plasmacytoma |language=de |journal=Archiv für Klinische und Experimentelle Dermatologie |volume=205 |issue=4 |pages=343–50 |year=1957 |pmid=13522017 |doi=10.1007/BF00693523|s2cid=10434333 }}
• Antiphospholipid syndrome due to small blood clots
• Hypercalcaemia (raised blood calcium levels which may be deposited in the capillaries)
• Haematological disorders of polycythaemia rubra vera or thrombocytosis (excessive red cells or platelets)
• Infections (infective endocarditis, syphilis, tuberculosis, Lyme disease)
• Associated with acute kidney injury due to cholesterol emboli status after cardiac catheterization
• Arteriosclerosis (cholesterol emboli){{cite journal |vauthors=Kazmier F, Sheps S, Bernatz P, Sayre G |title=Livedo reticularis and digital infarcts: a syndrome due to cholesterol emboli arising from atheromatous abdominal aortic aneurysms |journal=Vasc Dis |volume=3 |issue=1 |pages=12–24 |year=1966 |pmid=5903590}}{{cite journal |vauthors=Stewart W, Lauret P, Testart J, Thomine E, Boulliê M, Leroy D |title=Les manifestations cutanées des emoblies de critaux de cholestérol |trans-title=Cutaneous cholesterol emboli |language=fr |journal=Ann Dermatol Venereol |volume=104 |issue=1 |pages=5–8 |year=1977 |pmid=843026}} and homocystinuria (due to Chromosome 21 autosomal recessive Cystathionine beta synthase deficiency)
• Intra-arterial injection (especially in drug addicts)
• Ehlers-Danlos syndrome – connective tissue disorder, often with many secondary conditions, may be present in all types
• Pheochromocytoma{{cite journal |doi=10.1210/jc.2012-2842 |pmid=23275529 |title=Livedo Reticularis in a Patient with Pheochromocytoma Resolving After Adrenalectomy |journal=The Journal of Clinical Endocrinology & Metabolism |volume=98 |issue=2 |pages=439–40 |year=2013 |last1=Buckley |first1=Sarah A. |last2=Lessing |first2=Juan N. |last3=Mark |first3=Nicholas M.|doi-access=free }}
• Livedoid vasculopathy and its association with factor V Leiden mutation{{cite journal |pmid=23268168 |title=Livedoid vasculopathy and its association with factor V Leiden mutation |url=http://www.sma.org.sg/UploadedImg/files/SMJ/5312/5312cr3.pdf |volume=53 |issue=12 |date=December 2012 |vauthors=Yong AA, Tan AW, Giam YC, Tang MB |journal=Singapore Med J |pages=e258–60 |access-date=2014-03-22 |archive-date=2016-03-04 |archive-url=https://web.archive.org/web/20160304060246/http://www.sma.org.sg/UploadedImg/files/SMJ/5312/5312cr3.pdf |url-status=live }}
• FILS syndrome (polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature){{cite journal |doi=10.1084/jem.20121303 |pmid=23230001 |pmc=3526359 |title=Polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature ('FILS syndrome') |journal=Journal of Experimental Medicine |year=2012 |first1=Jana |last1=Pachlopnik Schmid |last2=Lemoine |first3=Nadine |last3=Nehme |first4=Valéry |last4=Cormier-Daire |first5=Patrick |last5=Revy |first6=Franck |last6=Debeurme |first7=Marianne |last7=Debré |first8=Patrick |last8=Nitschke |first9=Christine |last9=Bole-Feysot |first10=Laurence |last10=Legeai-Mallet |first11=Annick |last11=Lim |first12=Jean-Pierre |last12=de Villartay |first13=Capucine |last13=Picard |first14=Anne |last14=Durandy |first15=Alain |last15=Fischer |first16=Geneviève |last16=de Saint Basile |volume=209 |issue=13 |pages=2323–30|url=http://www.zora.uzh.ch/75774/1/PachlopnikSchmidJ%2C_2012.pdf }}
• Primary hyperoxaluria, oxalosis (oxalate vasculopathy){{cite journal |doi=10.1016/j.ad.2012.04.019 |title=Oxalosis y livedo reticularis |trans-title=Oxalosis and Livedo Reticularis |language=es |journal=Actas Dermo-Sifiliográficas |volume=104 |issue=9 |pages=815–8 |year=2013 |last1=Jorquera-Barquero |first1=E.|last2=Súarez-Marrero |first2=M.C. |last3=Fernández Girón |first3=F. |last4=Borrero Martín |first4=J.J. |pmid=23103120|doi-access=free }}{{cite journal |title=Primary hyperoxaluria in a 27-year-old woman |pmid=14512927 | volume=49 | issue=4 |date=October 2003 |vauthors=Bogle MA, Teller CF, Tschen JA, Smith CA, Wang A |journal=J. Am. Acad. Dermatol. |pages=725–8|doi=10.1067/s0190-9622(03)00119-1 }}{{cite journal |title=Primary hyperoxaluria: report of a patient with livedo reticularis and digital infarcts |pmid=11807460 | volume=46 | issue=2 Suppl Case Reports |date=February 2002 |vauthors=Marconi V, Mofid MZ, McCall C, Eckman I, Nousari HC |journal=J. Am. Acad. Dermatol. |pages=S16–8 |doi=10.1067/mjd.2002.105475}}{{cite journal |title=Livedo reticularis, ulcers, and peripheral gangrene: cutaneous manifestations of primary hyperoxaluria |pmid=11030785 | volume=136 | issue=10 |date=October 2000 |vauthors=Shih HA, Kao DM, Elenitsas R, Leyden JJ |journal=Arch Dermatol |pages=1272–4|doi=10.1001/archderm.136.10.1272-a |doi-broken-date=2 December 2024 |s2cid=32702914 }}{{cite journal |title= Steroid-responsive pleuropericarditis and livedo reticularis in an unusual case of adult-onset primary hyperoxaluria |pmid=10196036 | volume=33 | issue=4 |date=April 1999 |vauthors=Singh S, Tai C, Ganz G, etal |journal=Am. J. Kidney Dis. |pages=e5.1–e5.6|doi=10.1016/s0272-6386(99)70246-5 }}
• Cytomegalovirus infection (very rare clinical form, presenting with persistent fever and livedo reticularis on the extremities and cutaneous necrotizing vasculitis of the toes){{cite journal |doi=10.1016/j.bjid.2012.08.002 |pmid=22975173 |title=Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: Case report and literature review |journal=The Brazilian Journal of Infectious Diseases |volume=16 |issue=5 |pages=482–5 |year=2012 |last1=Arslan |first1=Ferhat |last2=Batirel |first2=Ayse |last3=Mert |first3=Ali |last4=Ozer |first4=Serdar|doi-access=free }}
• Generalized livedo reticularis induced by silicone implants for soft tissue augmentation{{cite journal |doi=10.1097/DAD.0b013e31821cb3c5 |pmid=22441370 |title=Generalized Livedo Reticularis Induced by Silicone Implants for Soft Tissue Augmentation |journal=The American Journal of Dermatopathology |volume=34 |issue=2 |pages=203–7 |year=2012 |last1=Camacho |first1=Diana |last2=Machan |first2=Shalma |last3=Pilesanski |first3=Ursula |last4=Revelles |first4=Juan Maria |last5=Martín |first5=Lucia |last6=Requena |first6=Luis}}
• As a rare skin finding in children with Down syndrome{{cite journal |title=Mucocutaneous disorders in children with down syndrome: case-controlled study |pmid=22303799 | volume=22 | issue=4 |year=2011 |vauthors=Bilgili SG, Akdeniz N, Karadag AS, Akbayram S, Calka O, Ozkol HU |journal=Genet. Couns. |pages=385–92}}{{cite journal |title=Mucocutaneous findings in 100 children with Down syndrome |pmid=17542890 | doi=10.1111/j.1525-1470.2007.00412.x | volume=24 |issue=3 |year=2007 |vauthors=Daneshpazhooh M, Nazemi TM, Bigdeloo L, Yoosefi M |journal=Pediatr Dermatol |pages=317–20|s2cid=25151006 }}
• Idiopathic livedo reticularis with polyclonal IgM hypergammopathy{{cite journal |title=John Libbey Eurotext : Éditions médicales et scientifiques France : revues, médicales, scientifiques, médecine, santé, livres |journal=European Journal of Dermatology |volume=21 |issue=2 |pages=266–7 |publisher=Jle.com |doi=10.1684/ejd.2010.1226 |pmid=21489905 |year=2011 |last1=ENDO |first1=Yuichiro |last2=MIYACHI |first2=Yoshiki |last3=YOSHIKAWA |first3=Yoshiaki }}
• CO₂ angiography (rare, reported case){{cite journal |doi=10.1016/j.jvir.2010.11.012|pmid=21277800|title=Livedo Reticularis and Bowel Ischemia after Carbon Dioxide Arteriography in a Patient with CREST Syndrome|journal=Journal of Vascular and Interventional Radiology|volume=22|issue=3|pages=395–9|year=2011|last1=Johnson|first1=Philip L.|last2=Neperud|first2=Julie|last3=Arnold|first3=Jill|last4=Thomas|first4=James}}
• A less common skin lesion of eosinophilic granulomatosis with polyangiitis{{cite journal |last1=Marzano |first1=AV |last2=Balice |first2=Y |last3=Tavecchio |first3=S |last4=Desimine |first4=C |last5=Colombo |first5=A |last6=Berti |first6=E |title=Granulomatous vasculitis |journal=Giornale Italiano di Dermatologia e Venereologia |date=April 2015 |volume=150 |issue=2 |pages=193–202 |pmid=25791629 |url=https://pubmed.ncbi.nlm.nih.gov/25791629/}}
• Erythema nodosum-like cutaneous lesions of sarcoidosis showing livedoid changes in a patient with sarcoidosis and Sjögren's syndrome{{cite journal |url=http://www.jle.com/en/revues/medecine/ejd/e-docs/00/04/5C/C9/article.phtml |title=John Libbey Eurotext : Éditions médicales et scientifiques France : revues, médicales, scientifiques, médecine, santé, livres |journal=European Journal of Dermatology |volume=20 |issue=5 |pages=640–641 |publisher=Jle.com |date= September 2010|access-date=2014-03-19 |url-status=dead |archive-url=https://archive.today/20140216190909/http://www.jle.com/en/revues/medecine/ejd/e-docs/00/04/5C/C9/article.phtml |archive-date=2014-02-16 |doi=10.1684/ejd.2010.1034 |pmid=20610374 |last1=Yamamoto |first1=Toshiyuki |last2=Takenoshita |first2=Hideo |doi-broken-date=1 November 2024 }}
• Livedo vasculopathy associated with IgM antiphosphatidylserine-prothrombin complex antibody{{cite journal |doi=10.2340/00015555-0835 |pmid=20526560 |title=Livedo Vasculopathy Associated with IgM Anti-phosphatidylserine-prothrombin Complex Antibody |journal=Acta Dermato Venereologica |volume=90 |issue=3 |pages=313–4 |year=2010 |last1=Tabata |first1=N |last2=Oonami |first2=K |last3=Ishibashi |first3=M |last4=Yamazaki |first4=M|doi-access=free }}
• Livedo vasculopathy associated with plasminogen activator inhibitor-1 promoter homozygosity and prothrombin G20210A heterozygosity
• As a first sign of metastatic breast carcinoma (very rare){{cite journal |doi=10.1111/j.1365-2230.2008.02801.x|pmid=19120398|title=Generalized livedo reticularis as the first sign of metastatic breast carcinoma|journal=Clinical and Experimental Dermatology|volume=34|issue=2|pages=253–4|year=2009|last1=Gambichler|first1=T.|last2=Baier|first2=P.|last3=Altmeyer|first3=P.|s2cid=1965405}}
• Livedo reticularis associated with renal cell carcinoma (rare){{cite journal |doi=10.1046/j.1365-4362.2001.00895.x|pmid=11454094|title=Livedo reticularis associated with renal cell carcinoma|journal=International Journal of Dermatology|volume=40|issue=4|pages=299–300|year=2001|last1=Erel|first1=Arzu|last2=Ozsoy|first2=Esra|last3=University|first3=Gazi|s2cid=46560722}}
• Buerger's disease (as an initial symptom){{cite journal |doi=10.2169/internalmedicine.46.0143 |pmid=17978541|title=Buerger's Disease Manifesting Nodular Erythema with Livedo Reticularis|journal=Internal Medicine|volume=46|issue=21|pages=1815–9|year=2007|last1=Takanashi|first1=Tetsuo|last2=Horigome|first2=Reiko|last3=Okuda|first3=Yasuaki|last4=Nose|first4=Masato|last5=Matsuda|first5=Masayuki|last6=Ikeda|first6=Shu-Ichi|doi-access=free}}
• As a rare manifestation of Graves hyperthyroidism{{cite journal |title=Livedo reticularis: a rare manifestation of Graves hyperthyroidism associated with anticardiolipin antibodies |pmid=15255431 | volume=97 | issue=6 |date=June 2004 |author=Liel Y |journal=South. Med. J. |pages=601–3 |doi=10.1097/00007611-200406000-00019}}
• Associated with pernicious anaemia{{cite journal |doi=10.1046/j.1365-2230.2003.01285_5.x|pmid=12823316|title=Celecoxib-induced fixed drug eruption|journal=Clinical and Experimental Dermatology|volume=28|issue=4|pages=452|year=2003|last1=Bandyopadhyay|first1=D.|s2cid=33331314}}
• Moyamoya disease (a rare, chronic cerebrovascular occlusive disease of unknown cause, characterized by progressive stenosis of the arteries of the circle of Willis leading to an abnormal capillary network and resultant ischemic strokes or cerebral hemorrhages){{cite journal |doi=10.1046/j.1525-1470.2003.20205.x|pmid=12657007|title=Livedo Reticularis in a Child with Moyamoya Disease|journal=Pediatric Dermatology|volume=20|issue=2|pages=124–7|year=2003|last1=Richards|first1=Kristen A.|last2=Paller|first2=Amy S.|s2cid=20135035}}
• Associated with the use of a midline catheter. ( atheroempolic renal DX )due to angioplasty{{cite journal |title=Livedo reticularis associated with the use of a midline catheter |pmid=12578157 | volume=34 | issue=11 |year=2002 |vauthors=Shrestha NK, Gordon SM, Isada CM |journal=Scand. J. Infect. Dis. |pages=845–6 |doi=10.1080/0036554021000026942|s2cid=42667906 }}
• Familial primary cryofibrinogenemia.{{cite journal |title=Familial primary cryofibrinogenemia|pmid=10188150 | volume=12 | issue=1 |date=January 1999 |vauthors=van Geest AJ, van Dooren-Greebe RJ, Andriessen MP, Blomjous CE, Go IH |journal=J Eur Acad Dermatol Venereol |pages=47–50 |doi=10.1111/j.1468-3083.1999.tb00808.x|s2cid=23748363 }}

Livedo reticularis is diagnosed by its clinical appearance and history. No further test or examination confirms idiopathic livedo reticularis. However, further investigations may be undertaken where an underlying cause is suspected such as skin biopsies, or blood tests for antibodies associated with antiphospholipid syndrome or systemic lupus erythematosus.{{cite web |url=https://www.dermnetnz.org/topics/livedo-reticularis/ |title=Livedo reticularis |last=Ngan |first=Vanessa |editor-last=Oakley |editor-first=Amanda |date=September 2016 |website=DermNet NZ |access-date=February 2, 2018 |archive-date=February 4, 2018 |archive-url=https://web.archive.org/web/20180204010133/https://www.dermnetnz.org/topics/livedo-reticularis/ |url-status=live }}

Other than identifying and treating any underlying conditions in secondary livedo,{{cite journal |vauthors=Fleischer A, Resnick S |title=Livedo reticularis |journal=Dermatol Clin |volume=8 |issue=2 |pages=347–54 |year=1990 |pmid=2191805|doi=10.1016/S0733-8635(18)30506-0 }} idiopathic livedo reticularis may improve with warming the area.

• Livedoid dermatitis
• Livedo racemosa
• Perinatal gangrene of the buttock
• erythema ab igne (AKA livedo recticularis e calore) - a rash caused by prolonged heat exposure (e.g. hot water bottle or heat pad)
• List of cutaneous conditions

{{Reflist}}

{{Medical resources

| DiseasesDB = 7546

| ICD10 = {{ICD10|R|23|1|r|20}}

| ICD9 = {{ICD9|782.61}}

| OMIM =

| MedlinePlus = 001478

| GeneReviewsName =

| ICDO =

| eMedicineSubj =

| eMedicineTopic =

| MeshID =

}}

• [http://www.dermnetnz.org/vascular/livedo-reticularis.html DermNet]

{{Skin and subcutaneous tissue symptoms and signs}}

Category:Vascular-related cutaneous conditions

Category:Rheumatology