Livedo reticularis in Child
Cutis marmorata (CM) is a transient, benign (physiologic) presentation of LR that may also be seen in pale, gravid females.
Congenital LR, known as cutis marmorata telangiectatica congenita (CMTC), is sporadically inherited (or autosomal dominant) and is associated with limb, facial, and spine anomalies along with cutaneous atrophy.
Many inherited vascular malformation syndromes are associated with CM or LR. LR is also associated with a host of other factors including anticardiolipin antibodies. It is seen with collagen vascular diseases such as Raynaud disease, systemic lupus erythematosus, dermatomyositis, scleroderma, polyarteritis nodosa, and temporal arteritis. In severe cases, the extremities are cold and ulcers may form.
Sneddon syndrome is extensive LR with central nervous system disease.
LR is also seen in patients with poor vascular flow due to peripheral vascular disease and cardiac failure, disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), vascular emboli, and vascular calcifications (in hypercalcemia). Infectious associations include syphilis, tuberculosis, streptococcemia, endocarditis, and rickettsial and viral diseases. Medication associations include amantadine, catecholamines, and quinidine; endocrine associations include hypothyroidism, pseudohypoparathyroidism, hypoparathyroidism, and Cushing syndrome.
R23.1 – Pallor
238772004 – Livedo reticularis
- Telangiectases (unilateral nevoid telangiectasia) – Seen in adolescent girls and during pregnancy.
- Hereditary benign telangiectasia – S familial disorder; is associated with cutaneous and labial telangiectases.
- Adams-Oliver syndrome – Has CMTC and aplasia cutis congenital of the scalp, sometimes with bony defects.
- Ataxia-telangiectasia syndrome – Manifests during childhood with telangiectasias and cerebellar ataxia.
- Divry-Van Bogaert syndrome – A rare disorder with LR and leptomeningeal angiomatosis during adolescence.
- Osler-Weber-Rendu (HHT) – Includes significant visceral and cutaneous arteriovenous malformations and is inherited in an autosomal dominant pattern.
- When there is purpura in addition to underlying livedo, vascular disease or vasculitis (polyarteritis nodosa, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis) should be considered.
- Active ulceration or atrophic scars suggest underlying pathological disease.
- Amantadine and other drugs are associated with a livedo reticularis pattern.
- Angioma serpiginosum
- Emboli or thrombosis