Livedo is the term used to describe the skin discoloration usually violet in color which appears as reticular or net like in structure. This discoloration is due to the disturbances in the blood circulation locally. The blood flow in the capillaries is obstructed due to small blood clots. This causes the swelling of the venules.
What is Livedo Reticularis?
Livedo Reticularis occurs due to the blood flow disturbance in the cutaneous tissue layer and is visible as reddish blue or purple net like patterns. This may be transient or persistent and may occur in various pathologic or physiologic states.
Any process which disturbs the blood flow to the skin causes the increase in deoxygenated hemoglobin. This deoxygenated hemoglobin is responsible for the mottled discoloration of the skin surrounding the pale central skin.
Livedo Reticularis Causes
- Any pathological or physiological process
- The reduction in blood flow to the skin which may be due to some disturbance.
- Reduction of oxygen tension at the outer layer of the skin segments.
- Disturbances in hormone balance
- When the regulatory systems are disturbed
- Symptoms of some serious underlying illness.
Livedo Reticularis Location
Livedo reticularis generally is found on the hands and legs and occasionally on the trunk.
What are the different types of livedo reticularis?
The types of livedo reticularis are:
- Primary livedo reticularis: Occurs due to unknown causes and is benign.
- Secondary livedo reticularis: Formed due to some underlying systemic disease.
- Livedo racemosa: Persistent form of livedo.
- Cutis marmorata: Variable livedo caused by physiologic state.
- Cutis marmorata telangiectatica congeita: It is a persistent livedo associated with congenital form.
When body is exposed to severe cold, physiological arteriolar vasospasm occurs and this results in the skin discoloration or the cutis marmorata. But this state is reversible. Livedo racemosa which is the persistent form of livedo is caused by prolonged thrombosis, hyperviscosity or the vasospasm and results in pathological skin changes.
Livedo reticularis is commonly associated with some autoimmune diseases like sclerosis and dermatomyositis. It has also been found in patients with rheumatoid arthritis.
What are the features of livedo reticularis?
The features of Livedo Reticularis are:
- The pattern is net like or lace like reticular pattern.
- The color varies from reddish-blue to purple.
- It mostly affects the legs.
- It becomes more intense and pronounced in cold weather conditions.
- Constant exposure to cold may result in numbness or tingling sensation in the affected area.
- In secondary livedo reticularis, the skin discoloration is more pronounced.
- But in cutis marmorata the skin discoloration is faint.
So who does this disorder of livedo reticularis affect?
People exposed to cold
This disorder shows up usually in middle aged females. Around half of the normal infants and young females get cutis marmorata when their body is exposed to cold weather.
Also cutis marmorata telangiectatica congenita affects people at birth. This is usually found on the lower extremes in the leg region.
People having infection like tuberculosis, bacterial and viral infection or rheumatic fever may develop this disorder.
There are proofs to show that patients with neurological disorder like the Parkinson disease, sclerosis and dystrophy develop livedo reticularis.
Among the underlying conditions, the malignant tumors found in the breast, renal cell and skin also give rise to livedo reticularis.
People taking some medications are also likely to develop this discoloration disorder.
Other factors or diseases like cholesterol emboli, septic emboli and pancreatitis also are responsible for livedo reticularis.
Drug addicts who take intra-arterial injections are likely to get this skin discoloration.
Livedo Reticularis Complications
Livedo reticularis is a benign disorder. It may give pain in the joints if it is associated with rheumatoid arthritis. Also very rarely it may cause some arterial events which may result in the death of patient.
Livedo Reticularis Diagnosis
This disorder is diagnosed by its physical appearance that is by observing the purple net like reticular structure and skin discoloration.
Proper Diagnosis using symptoms
Correct investigation is undertaken by studying the patient’s previous medical history and relating it to the present symptoms, if any exists.
It is advisable to take two biopsies from the skin discoloration areas. Even while removing the sample for biopsy, it is required that the sample be taken from the medium vessel found in the deep reticular dermis. This increases the chance of yielding results.
Livedo Reticularis Treatment
Physiologic livedo reticularis
For people with physiologic livedo reticularis, counseling is the best option. It doesn’t require medication. They should avoid venturing out in the cold. Stockings or full length socks should be worn. This condition improves when taken care of.
Inflammatory livedo reticularis
For treatment of inflammatory livedo reticularis, anti-inflammatory drugs and systemic immunosuppressants are given.
Secondary livedo reticularis
For patients with secondary livedo reticularis, the condition improves when the underlying cause is found and treated.
For the disorder as such, exercises to improve blood circulation is the best treatment. Such exercises help in increased blood circulation throughout the body and thus help in treating the disorder.
For some the symptoms may improve with age. Most importantly the patients require emotional support and care.
Livedo Reticularis Pictures
Any disorder requires proper diagnosis first. Only when the diagnosis is proper then the medications also act properly. Furthermore only when the patient cooperates by taking medications on time does the disorder heal.