Livedoid vasculitis

Livedoid vasculitis (also known as "livedo vasculitis", livedo reticularis, and "livedoid vasculopathy") is a vascular disorder mostly affecting women. It may be aggravated by exposure to cold and occurs most often in the lower extremities. It can also be associated with the presence of anti-cardiolipin antibodies (the Antiphospholipid syndrome).

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The condition's name derives from the Latin livere meaning bluish.

Etiology

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.^[1]
• Idiopathic livedo reticularis - is the commonest cause of livedo reticularis appearance and is a completely benign condition of unknown cause affecting mostly young women during the winter.^[2] May be mild, but ulceration may occur later in the summer.^[3]
• Secondary livedo reticularis:
  • Vasculitis autoimmune conditions:
    • Livedoid vasculitis - with painful ulceration occurring in the lower legs
    • Polyarteritis nodosa
    • Systemic lupus erythematosus^[4]
    • Dermatomyositis
    • Rheumatoid arthritis
    • Lymphoma
    • Pancreatitis^[5]
    • Tuberculosis
    • Amantadine (drug)
  • Obstruction of capillaries:
    • Cryoglobulinaemia - proteins in the blood that clump together in cold conditions.^[6]
    • Antiphospholipid syndrome due to small blood clots
    • Hypercalcaemia (raised blood calcium levels which may be deposited in the capillaries)
    • Haematological disorders of Polycythaemia rubra vera or Thrombocytosis (excessive red cells or platelets)
    • Infections (syphilis and tuberculosis)
    • Arteriosclerosis (cholesterol emboli)^[7][8] and homocystinuria (due to Chromosome 21 autosomal recessive Cystathionine beta synthase deficiency)
    • Intra-arterial injection (especially in drug addicts)

Treatment

Other than identifying and treating any underlying conditions in secondary livedo,^[9] idiopathic livedo reticularis itself may improve with warming the legs, but once established the skin discolouration may become permanent.

• DermNet vascular/livedo-vascularis