Livedo Reticularis

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R23.1 – Pallor

238772004 – Livedo reticularis


Livedo reticularis is a vascular reaction pattern characterized by a reticular (netlike) discoloration on the extremities and trunk. It is caused by decreased blood flow to the skin or impaired outflow in the dermal venous plexus and stagnation of the blood within these vessels. The darker, discolored areas represent accumulation of deoxygenated blood. Etiologic categories include vasospasm, vessel wall dysfunction (eg, vasculitis), and vascular flow compromise as in coagulopathies. Livedo reticularis is exacerbated by cold temperatures. It may be physiologic (cutis marmorata), a primary disease (as in idiopathic cases), or associated with other conditions such as collagen vascular diseases. Livedo reticularis is frequently seen in patients with Raynaud's disease.

Localized forms may be associated with vasculitis. In severe cases, the extremities are cold and ulcers may form. Sneddon syndrome is extensive diffuse livedo reticularis in a typical racemose, or broken, pattern with cerebrovascular disease (from transient ischemic attacks to frank cerebrovascular accidents); hypertension and antiphospholipid antibodies are often present. Livedo reticularis is also seen in patients with poor vascular flow (eg, peripheral vascular disease and cardiac failure). There is strong literature evidence for currently used drugs – amantadine, quinidine, and catecholamines – as triggers. Drugs used in the past to treat syphilis – bismuth and arsphenamine – also caused livedo reticularis.

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