Overview

Livedo reticularis is a skin condition characterized by a mottled, purplish, net-like or lace-like pattern on the skin. It is most commonly seen on the legs, arms, or trunk, and becomes more noticeable in cold temperatures. The condition occurs when there is a disturbance in blood flow to the skin, causing deoxygenated blood to pool in the small vessels near the surface. Livedo reticularis can be a harmless physiological response to cold or a sign of an underlying medical condition that affects circulation or the vascular system.

Causes

Livedo reticularis can be categorized into two types: physiological (benign) and pathological (associated with disease). Common causes include:

• Physiological causes: Exposure to cold temperatures can temporarily cause livedo reticularis in healthy individuals as blood vessels constrict.
• Autoimmune diseases: Conditions such as lupus erythematosus or antiphospholipid syndrome can lead to chronic livedo reticularis.
• Vascular conditions: Disorders affecting blood flow, like vasculitis or peripheral arterial disease, can result in this skin pattern.
• Blood clotting disorders: Hypercoagulable states, including antiphospholipid antibody syndrome, increase the risk of livedo reticularis.
• Medications: Certain drugs, such as amantadine or catecholamines, may cause livedo reticularis as a side effect.
• Infections: Chronic infections like tuberculosis or syphilis have been associated with this condition in some cases.
• Endocrine issues: Disorders such as hypothyroidism can also be linked to livedo reticularis.

Symptoms

The hallmark symptom of livedo reticularis is a characteristic skin appearance, often accompanied by other signs depending on the cause:

• Mottled, purplish-blue skin discoloration arranged in a net-like or lace-like pattern.
• Color changes become more noticeable in cold weather and may fade with warming.
• Commonly affects the legs, thighs, arms, and sometimes the trunk.
• In pathological cases, it may persist regardless of temperature changes.
• Skin may feel cool to the touch but typically remains painless.
• In some cases, associated symptoms like ulcers, pain, or numbness may occur if related to an underlying disease.

Diagnosis

Diagnosing livedo reticularis involves a physical examination and consideration of medical history to determine if it is benign or indicative of an underlying condition:

• Clinical evaluation: A visual assessment of the skin pattern and its response to temperature changes.
• Medical history: Reviewing any associated symptoms, history of autoimmune diseases, or blood clotting disorders.
• Blood tests: To check for autoimmune markers, clotting disorders, or signs of infection.
• Skin biopsy: In unclear cases, a biopsy may be performed to examine blood vessel structure and rule out vasculitis.
• Imaging studies: Doppler ultrasound or other vascular imaging may be used if circulation issues are suspected.

Treatment

Treatment for livedo reticularis depends on whether it is physiological or pathological:

• Benign cases: No treatment is typically necessary. Managing exposure to cold and improving circulation with warm clothing can minimize symptoms.
• Addressing underlying conditions: Treating autoimmune diseases, vascular problems, or infections can lead to improvement in skin appearance.
• Medication adjustments: Discontinuing or changing medications that may trigger the condition if appropriate.
• Blood thinners: In cases linked to clotting disorders, anticoagulant therapy may be prescribed.
• Vasodilators: Medications that help dilate blood vessels can improve blood flow in some patients.
• Lifestyle changes: Regular physical activity, avoiding smoking, and maintaining a healthy diet support overall vascular health.

Prognosis

The prognosis of livedo reticularis depends on the underlying cause. In benign cases, it is harmless and resolves with warming or improved circulation. Pathological livedo reticularis may persist and serve as an indicator of more serious systemic conditions. Managing the root cause generally improves skin symptoms and overall health outcomes. Long-term follow-up may be required for individuals with autoimmune or vascular diseases to monitor progression and prevent complications.