Differential Diagnosis for Lacey Reticular Pattern on Skin
The presence of a lacy reticular pattern on the skin, particularly on the back, can be indicative of several conditions. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Livedo Reticularis: This condition is characterized by a mottled, reticular discoloration of the skin, often appearing as a lacy pattern. It can be primary (idiopathic) or secondary to various factors such as cold temperatures, smoking, or underlying diseases like vasculitis or autoimmune disorders. The pattern is usually more pronounced in colder environments and can resolve with warming of the skin.
Other Likely Diagnoses
- Cutis Marmorata: A benign condition that presents with a mottled, reticular appearance of the skin, typically in response to cold temperatures. It is more common in infants and young children but can occur in adults as well.
- Physiological Livedo: A normal variant that can appear as a lacy pattern, especially in the legs. It may become more visible in certain conditions or with age.
- Vasculitis: Certain types of vasculitis, such as cutaneous polyarteritis nodosa or rheumatoid vasculitis, can present with livedo reticularis as part of their clinical manifestations.
Do Not Miss Diagnoses
- Antiphospholipid Syndrome (APS): A condition characterized by the presence of antiphospholipid antibodies, which can lead to arterial or venous thrombosis. Livedo reticularis is a common skin manifestation of APS, and missing this diagnosis could lead to significant morbidity or mortality due to thrombotic events.
- Sneddon Syndrome: A rare condition characterized by livedo reticularis and cerebrovascular events. It is essential to consider this diagnosis to prevent or manage potential strokes.
- Cholesterol Crystal Embolization: This condition can cause livedo reticularis, especially in the setting of recent vascular procedures or in patients with severe atherosclerosis. It is crucial to recognize this condition due to its potential for significant morbidity.
Rare Diagnoses
- Sjögren's Syndrome: An autoimmune disorder that can rarely present with livedo reticularis among its myriad manifestations.
- Systemic Lupus Erythematosus (SLE): While SLE can cause a wide range of skin manifestations, livedo reticularis is a less common but recognized feature of this disease.
- Cryoglobulinemia: A condition characterized by the presence of cryoglobulins (proteins that precipitate in cold temperatures) in the blood, which can lead to vasculitis and livedo reticularis.