Journal Information
Vol. 99. Issue 8.
Pages 598-607 (October 2008)
Share
Share
Download PDF
More article options
Vol. 99. Issue 8.
Pages 598-607 (October 2008)
Practical dermatology
Full text access
Diagnosis and Treatment of Livedo Reticularis on the Legs
Livedo Reticularis de las Piernas: Metodología de Diagnóstico y Tratamiento
Visits
52393
C. Herrero
Corresponding author
cherrero@clinic.ub.es

Correspondence: Servicio de Dermatología, Hospital Clínic, C/ Villarroel, 170, 08036 Barcelona, Spain.
, A. Guilabert, J.M. Mascaró-Galy
Dermatology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract

The term livedo reticularis refers to a reddish-violet reticular discoloration of the skin that mainly affects the limbs. It is caused by an interruption of blood flow in the dermal arteries, either due to spasm, inflammation, or vascular obstruction, and is associated with diseases of varying etiology and severity. To establish the cause of livedo reticularis, it is essential to determine its course (chronic, acute, or fulminant), the presence of other cutaneous signs such as nodules, retiform purpura or necrosis, and the possible association of general symptoms or laboratory findings that suggest a particular systemic process. The aim of this review is to describe the diagnosis and treatment of the disease.

Key words:
livedo reticularis
retiform purpura
livedo racemosa
vasculitis
cholesterol emboli
calciphylaxis
antiphospholipid antibodies
Resumen

El término livedo reticularis describe un retículo cutáneo de coloración rojo-violácea que afecta preferentemente a las extremidades. Su origen es la interrupción del flujo sanguíneo en las arteriolas dérmicas, ya sea por espasmo, inflamación u obstrucción intravascular, y se asocia a entidades de diversa etiología y gravedad. Para establecer la causa de una livedo reticularis es fundamental conocer la evolución del cuadro (si la livedo reticularis es o bien crónica o bien aguda o fulminante), la presencia de otros signos cutáneos, como nódulos, púrpura retiforme o necrosis, y la posible asociación con síntomas generales y/o datos analíticos que apunten hacia un determinado proceso sistémico. El objetivo de esta revisión es proporcionar un método diagnóstico y terapéutico para el abordaje de la livedo reticularis.

Palabras clave:
livedo reticularis
púrpura retiforme
livedo racemosa
vasculitis
émbolos de colesterol
calcifilaxia
síndrome antifosfolípido
Full text is only aviable in PDF
References
[1.]
A.B. Ackerman.
Histologic diagnosis of inflammatory skin diseases.
A method by pattern analysis, 1st ed., Lea Febiger, (1978),
[2.]
C. Frances, T. Papo, B. Wechsler, J.L. Laporte, V. Biousse, J.C. Piette.
Sneddon syndrome with or without antiphospholipid antibodies. A comparative study in 46 patients.
Medicine (Baltimore), 78 (1999), pp. 209-219
[3.]
J.P. Callen.
Livedoid Vasculopathy: What it is and how the patient should be evaluated and treated.
Arch Dermatol, 142 (2006), pp. 1481-1482
[4.]
B.R. Hairston, M. Davis, M.R. Pittelkow, I. Ahmed.
Livedoid Vasculopathy: Further evidence for procoagulant pathogenesis.
Arch Dermatol, 142 (2006), pp. 1413-1418
[5.]
J.A. Carlson, K.R. Chen.
Cutaneous vasculitis update: Neutrophilic muscular vessel and eosinophilic, granulomatous, and lymphocytic vasculitis syndromes.
Am J Dermatopathol, 29 (2007), pp. 32-43
[6.]
X. Bosch, A. Guilabert, J. Font.
Antineutrophil cytoplasmic antibodies.
The Lancet, 368 (2006), pp. 404-418
[7.]
J.A. Carlson, K.R. Chen.
Cutaneous Pseudovasculitis.
Am J Dermatopathol, 29 (2007), pp. 44-55
[8.]
R. Grau.
Pseudovasculitis: mechanisms of vascular injury and clinical spectrum.
Curr Rheumatol Rep, 4 (2002), pp. 83-89
[9.]
J.E. Blume, C.C. Miller.
Antiphospholipid syndrome: a review and update for the dermatologist.
Cutis, 78 (2006), pp. 409-415
[10.]
J.J. Grob, J.J. Bonerandi.
Cutaneous manifestations associated with the presence of the lupus anticoagulant. A report of two cases and a review of the literature.
J Am Acad Dermatol, 15 (1986), pp. 211-219
[11.]
Y.B. Oh, J.B. Jun, C.K. Kim, C.W. Lee, C.K. Park, T.Y. Kim, et al.
Mixed connective tissue disease associated with skin defects of livedoid vasculitis.
Clin Rheumatol, 19 (2000), pp. 381-384
[12.]
K.M. Acland, A. Darvay, S.H. Wakelin, R. Russell-Jones.
Livedoid vasculitis: a manifestation of the antiphospholipid syndrome?.
Br J Dermatol, 140 (1999), pp. 131-135
[13.]
K.T. Calamia, M. Balabanova, C. Perniciario, J.S. Walsh.
Livedo (livedoid) vasculitis and the factor V Leiden mutation: additional evidence for abnormal coagulation.
J Am Acad Dermatol, 46 (2002), pp. 133-137
[14.]
A. Boyvat, N. Kundakci, M.O. Babikir, E. Gurgey.
Livedoid vasculopathy associated with heterozygous protein C deficiency.
Br J Dermatol, 143 (2000), pp. 840-842
[15.]
M.D. Tran, P.A. Becherel, N. Cordel, J.C. Piette, C. Frances.
«Idiopathic» white atrophy.
Ann Dermatol Venereol, 128 (2001), pp. 1003-1007
[16.]
A. Deng, C.D. Gocke, J. Hess, M. Heyman, M. Paltiel, A. Gaspari.
Livedoid vasculopathy associated with plasminogen activator inhibitor-1 promoter homozygosity (4G/4G) treated successfully with tissue plasminogen activator.
Arch Dermatol, 142 (2006), pp. 1466-1469
[17.]
L. Requena, H. Kutzner, J. Angulo, G. Renedo.
Generalized livedo reticularis associated with monoclonal cryoglobulinemia and multiple myeloma.
J Cutan Pathol, 34 (2007), pp. 198-202
[18.]
A. Morell, R. Botella, J.E. Silvestre, I. Betlloch, M.R. Alfonso, M.D. Ruiz.
Livedo reticularis and thrombotic purpura related to the use of diphenhydramine associated with pyrithyldione.
Dermatology, 193 (1996), pp. 50-51
[19.]
N. Labropoulos, D. Manalo, N.P. Patel, J. Tiongson, L. Pryor, A.D. Giannoukas.
Uncommon leg ulcers in the lower extremity.
J Vasc Surg, 45 (2007), pp. 568-573
[20.]
E. Ruzzon, M.L. Raudi, F. Tezza, G. Luzzatto, R. Scandellari, F. Fabris.
Leg ulcers in elderly on hydroxyurea: a single disorder in Ph-myeloproliferative disorders and review of literature.
Aging Clin Exp Res, 18 (2006), pp. 187-190
[21.]
M.E. Sirieix, C. Debure, N. Baudot, L. Dubertret, M.E. Roux, O. Morel, et al.
Leg ulcers and hydroxyurea: forty-one cases.
Arch Dermatol, 135 (1999), pp. 818-820
[22.]
P. Duffau, M. Beylot-Barry, J Palussiere, S. Ly, O. Cogrel.
Necrotic livedo after vertebroplasty.
Br J Dermatol, 156 (2007), pp. 382-383
[23.]
M. Yebenes, M. Gilaberte, A. Toll, C. Barranco, R.M. Pujol.
Púrpura retiforme después de inyección intraarterial accidental de polidocanol.
Acta Derm Venéreol, 85 (2005), pp. 372-373
[24.]
A. Jucgla, F. Moreso, C. Muniesa, A. Moreno, A. Vidaller.
Cholesterol embolism: still an unrecognized entity with a high mortality rate.
J Am Acad Dermatol, 55 (2006), pp. 786-793
[25.]
W.K. Nahm, E. Badiavas, D.J. Touma, C.S. Wilkel, V. Falanga.
Calciphylaxis with peau d’orange induration and absence of classical features of purpura, livedo reticularis and ulcers.
J Dermatol, 29 (2002), pp. 209-213
[26.]
V.C. Kyttaris, S. Timbil, D. Kalliabakos, G. Vaiopoulos, A. Weinstein.
Calciphylaxis: a pseudo-vasculitis syndrome.
Semin Arthritis Rheum, 36 (2007), pp. 264-267
[27.]
M.A. Bogle, C.F. Teller, J.A. Tschen, C.A. Smith, A. Wang.
Primary hyperoxaluria in a 27-year-old woman.
J Am Acad Dermatol, 49 (2003), pp. 725-728
[28.]
A.M. Manganoni, M. Venturini, F. Scolari, G. Tucci, F. Facchetti, S. Graifemberhi, et al.
The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism.
Br J Dermatol, 150 (2004), pp. 1230-1231
[29.]
S.C. Somach, B.R. Davis, F.A. Paras, M. Petrelli, M.E. Behmer.
Fatal cutaneous necrosis mimicking calciphylaxis in a patient with type 1 primary hyperoxaluria.
Arch Dermatol, 131 (1995), pp. 821-823
[30.]
C. Ribi, D. Mauget, J.F. Egger, G. Khatchatourian, J. Villard.
Pseudovasculitis and corticosteroid therapy.
Clin Rheumatol, 24 (2005), pp. 539-543
[31.]
C. García-García.
Anticuerpos antifosfolípido y síndrome antifosfolípido: actitudes diagnósticas y terapéuticas.
Actas Dermosifiliogr, 98 (2007), pp. 16-23
[32.]
S.S. Lee, P. Ang, S.H. Tan.
Clinical profile and treatment outcome of livedoid vasculitis: a case series.
Ann Acad Med Singapore, 32 (2003), pp. 835-839
[33.]
S. Schanz, A. Ulmer, G. Fierlbeck.
Intravenous immunoglobulin in livedo vasculitis: a new treatment option?.
J Am Acad Dermatol, 49 (2003), pp. 555-556
[34.]
L. Amato, C. Chiarini, S. Berti, D. Massi, P. Fabbri.
Idiopathic atrophie blanche.
Skinmed, 5 (2006), pp. 151-154
[35.]
N. Sepp.
Other vascular disorders.
Dermatology, pp. 1651-1659
Copyright © 2008. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Download PDF
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?