From the Research
Livedo reticularis is a significant risk factor for thrombosis and should be evaluated promptly to rule out underlying conditions such as antiphospholipid syndrome (APS) or systemic lupus erythematosus (SLE), as evidenced by a recent meta-analysis showing a 2.91-fold increased risk of livedo in aPL-positive patients compared to aPL-negative patients 1.
Introduction to Livedo Reticularis
Livedo reticularis is a skin condition characterized by a persistent, net-like pattern of reddish-blue discoloration on the skin, typically appearing on the legs, arms, and sometimes the trunk. This condition occurs when blood vessels under the skin dilate and become visible, creating a mottled or lacy appearance.
Causes and Associations
Treatment depends on the underlying cause, as livedo reticularis can be benign (primary) or a symptom of another condition (secondary). For primary livedo reticularis, which is often triggered by cold exposure, keeping the affected areas warm with appropriate clothing and avoiding cold temperatures is recommended. Secondary livedo reticularis requires addressing the underlying condition, which may include autoimmune disorders like lupus, blood disorders, or medication side effects. The presence of livedo reticularis has been associated with an increased risk of cerebrovascular accidents, migraines, and epilepsy, as well as cardiac valve thickening and vegetations 2.
Clinical Evaluation and Management
If you notice this skin pattern, especially if accompanied by other symptoms like joint pain, fever, or if it persists despite warming, consult a healthcare provider for proper evaluation. The pattern occurs because of irregular blood flow in the small vessels of the skin, with some areas receiving less oxygen, causing the characteristic discoloration. While often harmless, persistent livedo reticularis warrants medical attention to rule out potentially serious underlying conditions. A recent study suggests that livedo reticularis could be a good candidate for inclusion in future classification criteria for antiphospholipid syndrome 1.
Key Considerations
- Livedo reticularis is a common cutaneous manifestation of APS and may be a prognostic marker of more severe disease 3.
- The underlying pathology involves prothrombotic as well as immunological processes with some overlap with APS 3.
- Treatment remains challenging and results are often variable, highlighting the need for prompt evaluation and management 3.
- The risk of livedo is significantly increased for most of aPL subtypes, including lupus anticoagulant (LA), IgG anticardiolipin, and IgG anti-β2-glycoprotein 1 1.