Livedo reticularis

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Livedo reticularis
Classification and external resources
ICD-10 R23.1
ICD-9-CM 782.61
DiseasesDB 7546
MedlinePlus 001478

Livedo reticularis is a common skin finding consisting of a mottled reticulated vascular pattern that appears as a lace-like purplish discoloration of the skin.[1] The discoloration is caused by swelling of the venules owing to obstruction of capillaries by small blood clots. The blood clots in the small blood vessels can be a secondary effect of a condition that increases a person's risk of forming blood clots, including a wide array of pathological and nonpathological conditions . Examples include hyperlipidemia, microvascular hematological or anemia states, nutritional deficiencies, hyper- and autoimmune diseases, and drugs/toxins.

The condition may be normal or related to more severe underlying pathology.[2] Its differential diagnosis is broadly divided into possible blood diseases, autoimmune (rheumatologic) diseases, cardiovascular diseases, cancers, and endocrine disorders. It can usually (in 80% of cases) be diagnosed by biopsy.[3]

It may be aggravated by exposure to cold, and occurs most often in the lower extremities.[citation needed]

The condition's name derives from the Latin livere meaning bluish and reticular which refers to the net-like appearance.[citation needed]


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[4]
  • Idiopathic livedo reticularis - the most common form of livedo reticularis, completely benign condition of unknown cause affecting mostly young women during the winter:[5] 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.[6]
  • Secondary livedo reticularis:
    • Vasculitis autoimmune conditions:
    • Drug-related:
    • Obstruction of capillaries:
    • Ehlers-Danlos syndrome—connective tissue disorder, often with many secondary conditions, may be present in all types
      • Beta IFN treatment, i.e. in multiple sclerosis[13][14][15]
      • Pheochromocytoma[16]
      • Livedoid vasculopathy and its association with factor V Leiden mutation[17]
      • FILS syndrome (polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature)[18]
      • Primary hyperoxaluria, oxalosis (oxalate vasculopathy)[19][20][21][22][23]
      • Cytomegalovirus infection (very rare clinical form, presenting with persistent fever and livedo reticularis on the extremities and cutaneous necrotizing vasculitis of the toes)[24]
      • Livedo reticularis associated with rasagiline[25]
      • Generalized livedo reticularis induced by silicone implants for soft tissue augmentation[26]
      • As a rare skin finding in children with Down syndrome[27][28]
      • Idiopathic livedo reticularis with polyclonal IgM hypergammopathy[29]
      • CO2 angiography (rare, reported case)[30]
      • A less common skin lesion of Churg-Strauss syndrome[31]
      • Erythema nodosum-like cutaneous lesions of sarcoidosis showing livedoid changes in a patient with sarcoidosis and Sjögren's syndrome[32]
      • Livedo vasculopathy associated with IgM antiphosphatidylserine-prothrombin complex antibody[33]
      • Livedo vasculopathy associated with plasminogen activator inhibitor-1 promoter homozygosity and prothrombin G20210A heterozygosity[33]
      • As a first sign of metastatic breast carcinoma (very rare)[34]
      • Livedo reticularis associated with renal cell carcinoma (rare)[35]
      • Methylphenidate and dextroamphetamine-induced peripheral vasculopathy[36]
      • Gefitinib[37]
      • Buerger's disease (as an initial symptom)[38]
      • As a rare manifestation of Graves hyperthyroidism[39]
      • Associated with pernicious anaemia[40]
      • Moyamoya disease (a rare, chronic cerebrovascular occlusive disease of unknown etiology, 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)[41]
      • Associated with the use of a midline catheter[42]
      • Familial primary cryofibrinogenemia.[43]


Other than identifying and treating any underlying conditions in secondary livedo,[44] idiopathic livedo reticularis may improve with warming the legs, but once established, the skin discolouration may become permanent.[citation needed]

See also[edit]


  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1615. ISBN 1-4160-2999-0. 
  2. ^ "livedo reticularis" at Dorland's Medical Dictionary
  3. ^ Kroshinsky; Stone, John H.; Bloch, Donald B.; Sepehr, Alireza (February 2009). "Case 5-2009 — A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs". New England Journal of Medicine 360 (7): 711–20. doi:10.1056/NEJMcpc0807822. PMID 19213685. 
  4. ^ Sneddon, I. B. (April 1965). "Cerebro-Vascular Lesions And Livedo Reticularis". British Journal of Dermatology 77 (4): 180–5. doi:10.1111/j.1365-2133.1965.tb14628.x. PMID 14278790.  |first2= missing |last2= in Authors list (help)
  5. ^ Gibbs, Mark B.; English, Joseph C.; Zirwas, Matthew J. (2005). "Livedo reticularis: an update". J Am Acad Dermatol 52 (6): 1009–19. doi:10.1016/j.jaad.2004.11.051. PMID 15928620. 
  6. ^ Feldaker M, Hines E, Kierland R (1955). "Livedo reticularis with summer ulcerations". AMA Arch Derm 72 (1): 31–42. doi:10.1001/archderm.1955.03730310033007. PMID 14387292. 
  7. ^ Golden R (March 1963). "Livedo reticularis in systemic lupus erythematosus". Arch Dermatol 87: 299–301. doi:10.1001/archderm.1963.01590150015002. PMID 13948706. 
  8. ^ Sigmund W, Shelley W (1954). "Cutaneous manifestations of acute pancreatitis, with special reference to livedo reticularis". N Engl J Med 251 (21): 851–3. doi:10.1056/NEJM195411182512104. PMID 13214346. 
  9. ^ Gould, Jennifer W.; Helms, Stephen E.; Schulz, Susan M.; Stevens, Seth R. (1998). "Relapsing livedo reticularis in the setting of chronic pancreatitis". Journal of the American Academy of Dermatology 39 (6): 1035–1036. doi:10.1016/S0190-9622(98)70290-7. PMID 9843029. 
  10. ^ Langhof H, Braun G, Matzkowski H (1957). "Livedo reticularis durch Kältegelierung des Blutes bei γ-Plasmocytom" [Livedo reticularis due to cold gelation of the blood by gamma-plasmacytoma]. Archiv für klinische und experimentelle Dermatologie (in German) 205 (4): 343–50. doi:10.1007/BF00693523. PMID 13522017. 
  11. ^ Kazmier F, Sheps S, Bernatz P, Sayre G (1966). "Livedo reticularis and digital infarcts: a syndrome due to cholesterol emboli arising from atheromatous abdominal aortic aneurysms". Vasc Dis 3 (1): 12–24. PMID 5903590. 
  12. ^ Stewart W, Lauret P, Testart J, Thomine E, Boulliê M, Leroy D (1977). "Les manifestations cutanées des emoblies de critaux de cholestérol" [Cutaneous cholesterol emboli]. Ann Dermatol Venereol (in French) 104 (1): 5–8. PMID 843026. 
  13. ^ Rot, Uroš; Ledinek, Alenka Horvat (December 2013). "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". Clinical Neurology and Neurosurgery 115 (Suppl 1): S79–81. doi:10.1016/j.clineuro.2013.09.027. PMID 24321162. 
  14. ^ Fox, Michelle; Tahan, Steven; Kim, Caroline C. (2012). "Livedo Reticularis: A Side Effect of Interferon Therapy in a Pediatric Patient with Melanoma". Pediatric Dermatology 29 (3): 333–5. doi:10.1111/j.1525-1470.2011.01426.x. PMID 21575046. 
  15. ^ Cruz, Boris Afonso; de Queiroz, Eustáquio; Nunes, Simone Vilela; Cruz Filho, Achiles; Campos, Gilberto Belisario; de Carvalho Monteiro, Ernesto Lentz; Crivellari, Humberto (2000). "Fênomeno de Raynaud grave associado a terapia com interferon-beta para esclerose múltipla: relato de caso" [Severe Raynaud's phenomenon associated with interferon-beta therapy for multiple sclerosis: case report]. Arquivos de Neuro-Psiquiatria (in Portuguese) 58 (2B): 556–9. doi:10.1590/S0004-282X2000000300025. PMID 10920422. 
  16. ^ Buckley, Sarah A.; Lessing, Juan N.; Mark, Nicholas M. (2013). "Livedo Reticularis in a Patient with Pheochromocytoma Resolving After Adrenalectomy". The Journal of Clinical Endocrinology & Metabolism 98 (2): 439–40. doi:10.1210/jc.2012-2842. 
  17. ^ Yong AA, Tan AW, Giam YC, Tang MB (December 2012). "Livedoid vasculopathy and its association with factor V Leiden mutation" (PDF). Singapore Med J 53 (12): e258–60. PMID 23268168. 
  18. ^ Pachlopnik Schmid, Jana; Lemoine; Nehme, Nadine; Cormier-Daire, Valéry; Revy, Patrick; Debeurme, Franck; Debré, Marianne; Nitschke, Patrick; Bole-Feysot, Christine; Legeai-Mallet, Laurence; Lim, Annick; de Villartay, Jean-Pierre; Picard, Capucine; Durandy, Anne; Fischer, Alain; de Saint Basile, Geneviève (2012). "Polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature ('FILS syndrome')". Journal of Experimental Medicine 209 (13): 2323–30. doi:10.1084/jem.20121303. PMC 3526359. PMID 23230001. 
  19. ^ Jorquera-Barquero, E.; Súarez-Marrero, M.C.; Fernández Girón, F.; Borrero Martín, J.J. (2013). "Oxalosis y livedo reticularis" [Oxalosis and Livedo Reticularis]. Actas Dermo-Sifiliográficas (in Spanish) 104 (9): 815–8. doi:10.1016/ PMID 23103120. 
  20. ^ Bogle MA, Teller CF, Tschen JA, Smith CA, Wang A (October 2003). "Primary hyperoxaluria in a 27-year-old woman". J. Am. Acad. Dermatol. 49 (4): 725–8. doi:10.1067/s0190-9622(03)00119-1. PMID 14512927. 
  21. ^ Marconi V, Mofid MZ, McCall C, Eckman I, Nousari HC (February 2002). "Primary hyperoxaluria: report of a patient with livedo reticularis and digital infarcts". J. Am. Acad. Dermatol. 46 (2 Suppl Case Reports): S16–8. doi:10.1067/mjd.2002.105475. PMID 11807460. 
  22. ^ Shih HA, Kao DM, Elenitsas R, Leyden JJ (October 2000). "Livedo reticularis, ulcers, and peripheral gangrene: cutaneous manifestations of primary hyperoxaluria". Arch Dermatol 136 (10): 1272–4. PMID 11030785. 
  23. ^ Singh S, Tai C, Ganz G, et al. (April 1999). "Steroid-responsive pleuropericarditis and livedo reticularis in an unusual case of adult-onset primary hyperoxaluria". Am. J. Kidney Dis. 33 (4): e5. doi:10.1016/s0272-6386(99)70246-5. PMID 10196036. 
  24. ^ Arslan, Ferhat; Batirel, Ayse; Mert, Ali; Ozer, Serdar (2012). "Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: Case report and literature review". The Brazilian Journal of Infectious Diseases 16 (5): 482–5. doi:10.1016/j.bjid.2012.08.002. PMID 22975173. 
  25. ^ Strowd, Lindsay C.; Lee, Andrew D.; Yosipovitch, Gil (June 2012). "Livedo Reticularis Associated With Rasagiline (Azilect)". Journal of Drugs in Dermatology 11 (6): 764–5. PMID 22648227. 
  26. ^ Camacho, Diana; Machan, Shalma; Pilesanski, Ursula; Revelles, Juan Maria; Martín, Lucia; Requena, Luis (2012). "Generalized Livedo Reticularis Induced by Silicone Implants for Soft Tissue Augmentation". The American Journal of Dermatopathology 34 (2): 203–7. doi:10.1097/DAD.0b013e31821cb3c5. PMID 22441370. 
  27. ^ Bilgili SG, Akdeniz N, Karadag AS, Akbayram S, Calka O, Ozkol HU (2011). "Mucocutaneous disorders in children with down syndrome: case-controlled study". Genet. Couns. 22 (4): 385–92. PMID 22303799. 
  28. ^ Daneshpazhooh M, Nazemi TM, Bigdeloo L, Yoosefi M (2007). "Mucocutaneous findings in 100 children with Down syndrome". Pediatr Dermatol 24 (3): 317–20. doi:10.1111/j.1525-1470.2007.00412.x. PMID 17542890. 
  29. ^ "John Libbey Eurotext : Éditions médicales et scientifiques France : revues, médicales, scientifiques, médecine, santé, livres". Retrieved 2014-03-19. [dead link]
  30. ^ Johnson, Philip L.; Neperud, Julie; Arnold, Jill; Thomas, James (2011). "Livedo Reticularis and Bowel Ischemia after Carbon Dioxide Arteriography in a Patient with CREST Syndrome". Journal of Vascular and Interventional Radiology 22 (3): 395–9. doi:10.1016/j.jvir.2010.11.012. PMID 21277800. 
  31. ^ Bosco, Laura; Peroni, Anna; Schena, Donatella; Colato, Chiara; Girolomoni, Giampiero (2010). "Cutaneous manifestations of Churg–Strauss syndrome: Report of two cases and review of the literature". Clinical Rheumatology 30 (4): 573–80. doi:10.1007/s10067-010-1593-1. PMID 20949297. 
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  33. ^ a b Tabata, N; Oonami, K; Ishibashi, M; Yamazaki, M (2010). "Livedo Vasculopathy Associated with IgM Anti-phosphatidylserine-prothrombin Complex Antibody". Acta Dermato Venereologica 90 (3): 313–4. doi:10.2340/00015555-0835. PMID 20526560. 
  34. ^ Gambichler, T.; Baier, P.; Altmeyer, P. (2009). "Generalized livedo reticularis as the first sign of metastatic breast carcinoma". Clinical and Experimental Dermatology 34 (2): 253–4. doi:10.1111/j.1365-2230.2008.02801.x. PMID 19120398. 
  35. ^ Erel, Arzu; Ozsoy, Esra; University, Gazi (2001). "Livedo reticularis associated with renal cell carcinoma". International Journal of Dermatology 40 (4): 299–300. doi:10.1046/j.1365-4362.2001.00895.x. PMID 11454094. 
  36. ^ Syed, Reema H.; Moore, Terry L. (2008). "Methylphenidate and Dextroamphetamine-Induced Peripheral Vasculopathy". JCR: Journal of Clinical Rheumatology 14: 30–33. doi:10.1097/RHU.0b013e3181639aaa. 
  37. ^ Blume, Jonathan E.; Miller, Craig C. (2007). "Livedo reticularis with retiform purpura associated with gefitinib (Iressa®)". International Journal of Dermatology 46 (12): 1307–8. doi:10.1111/j.1365-4632.2007.03319.x. PMID 18173531. 
  38. ^ Takanashi, Tetsuo; Horigome, Reiko; Okuda, Yasuaki; Nose, Masato; Matsuda, Masayuki; Ikeda, Shu-Ichi (2007). "Buerger's Disease Manifesting Nodular Erythema with Livedo Reticularis". Internal Medicine 46 (21): 1815–9. doi:10.2169/internalmedicine.46.0143. PMID 17978541. 
  39. ^ Liel Y (June 2004). "Livedo reticularis: a rare manifestation of Graves hyperthyroidism associated with anticardiolipin antibodies". South. Med. J. 97 (6): 601–3. doi:10.1097/00007611-200406000-00019. PMID 15255431. 
  40. ^ Bandyopadhyay, D. (2003). "Celecoxib-induced fixed drug eruption". Clinical and Experimental Dermatology 28 (4): 452. doi:10.1046/j.1365-2230.2003.01285_5.x. 
  41. ^ Richards, Kristen A.; Paller, Amy S. (2003). "Livedo Reticularis in a Child with Moyamoya Disease". Pediatric Dermatology 20 (2): 124–7. doi:10.1046/j.1525-1470.2003.20205.x. PMID 12657007. 
  42. ^ Shrestha NK, Gordon SM, Isada CM (2002). "Livedo reticularis associated with the use of a midline catheter". Scand. J. Infect. Dis. 34 (11): 845–6. doi:10.1080/0036554021000026942. PMID 12578157. 
  43. ^ van Geest AJ, van Dooren-Greebe RJ, Andriessen MP, Blomjous CE, Go IH (January 1999). "Familial primary cryofibrinogenemia". J Eur Acad Dermatol Venereol 12 (1): 47–50. doi:10.1111/j.1468-3083.1999.tb00808.x. PMID 10188150. 
  44. ^ Fleischer A, Resnick S (1990). "Livedo reticularis". Dermatol Clin 8 (2): 347–54. PMID 2191805. 

External links[edit]