Livedo reticularis (LR), a skin symptom is a netlike pattern of reddish-blue skin discoloration. Hebra used the term livedo more than a century ago to describe a violet skin discoloration due to an abnormality of the local blood circulation. The condition is linked to swollen blood vessels and the legs are often affected. Sometimes livedo reticularis is simply the result of being chilled however it may be a symptom of a serious underlying condition and hence shouldn’t be ignored. And it may occur as a side effect of certain medications. Usually there is no pain and sometimes, the face, trunk, buttocks, hands and feet are also involved. However, pain and ulcers can develop if blood flow is completely blocked. It worsens with the cold temperature. It is a manifestation of cutaneous blood flow disturbance that may occur in a variety of physiologic and pathologic states. They may be benign or serious. Benign LR is seen in physiologic cutis marmorata of infancy whereas serious LR is seen in the vasculitis of lupus erythematosus.
Two different patterns of livedo was observed by Ehrmann in 1907 the physiological LR and the pathological livedo racemosa (LRC). In both the forms livid rings are found caused by reduced blood flow and lowered oxygen tension at the peripheries of the skin segments. LR is a benign, primary disorder that affects young to middle-aged females. Unlike LRC, conical discoloration in LR is symmetric, reversible, and uniform. LRC is pathologic and permanent in spite of being secondary disorder. This distinction between LRC and LR is a newer concept in the literature. In comparison to LR, LRC is associated with a number of pathological conditions. LR has been differentiated into four distinct entities physiological, primary, idiopathic, and amantadine-induced which is based on duration of the livedo pattern and its association with ambient temperature. Striking characteristics of LRC are violaceous net-like pattern of the skin similar to LR, only differing by its location (more generalized and widespread, noninfiltrated, found on the limbs, trunk, and buttocks), its shape (irregular, broken, circular segments), and its biopsy results.
Avoidance of cold is the first medical treatment for primary LR. But in some cases, vasodilator therapy may be tried in the patient for cosmetic purpose. Sometimes symptoms improve spontaneously with age. Whereas, LRC therapy should be directed toward the underlying disorder. Livedoid vasculopathy treatment is not promising but potentially beneficial medications include anticoagulants, antiplatelet agents, immunosuppressants, pentoxifylline, danazol, and tissue plasminogen activator. Light therapies like Hyperbaric oxygen and psoralen and ultraviolet have also been successfully utilized in some cases for vasculopathy.
Rational evaluation of patients presenting with this distinctive net-like vascular pattern in the skin is necessary to understand the spectrum of diseases associated with LR. In adults, the most frequently associated diseases are characterized by vessel wall disease or intravascular obstruction. In the former group, lupus erythematosus is particularly important, because LR along with anticardiolipin antibodies are markers of serious cerebrovascular and renal disease. Appropriate patient evaluation includes a careful history and physical examination. Other useful screening methods are complete blood count, platelets, coagulation profile, cryoproteins, antinuclear antibodies, and anticardiolipin antibodies, for the important associated systemic diseases.