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Clinical Summary

Livedo reticularis is a reactive macular, reticulated (net-like) patch of nonpalpable cutaneous vasodilatation due to normal physiologic variation, vasospasm, vessel wall damage, or intraluminal pathology. It occurs in many systemic diseases including connective tissue disorders, vasculitis, polycythemia vera, cold agglutinins, hypercoagulability, thrombotic thrombocytopenic purpura, embolic disease, decompression sickness, and infections/sepsis. It has been associated with medications such as amantadine, quinine, and quinidine. Physiologic livedo reticularis is a response to cold temperatures and is a common finding in infants, children, and adults prone to acrocyanosis.

Management and Disposition

Management is dependent on identifying and treating the underlying disorder. Patients without an acute medical condition can be referred to dermatology.

Pearls

  1. Physiologic livedo reticularis improves or disappears with warming, whereas secondary causes usually do not.

  2. Patchy, nonsymmetrical distribution of livedo reticularis should elicit concern for more serious underlying diseases.

FIGURE 13.47

Livedo Reticularis. A netlike, arborizing pattern defined by violaceous, erythematous streaks resembling lightning. The skin within the erythematous areas is normally pale. (Used with permission from Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw Hill; 2013: Fig. 14-42.)

FIGURE 13.48

Livedo Reticularis. Reticulated (lacelike) branching erythema symmetrically distributed over the lower extremities (Photo contributor: James J. Nordlund, MD.)

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