Livedo Reticularis

Gabriele Muekusch; Judith Pitman

Disclosures

Dermatology Nursing. 2004;16(2):181 

Onset 2 years ago in right wrist area, which was initially swollen and painful. Anti-inflammatory drugs were prescribed with little improvement. Swelling and pain then developed in both ankles and shortly afterwards a nonpruritic blotchy erythematous rash developed on lower extremities. The rash did not change with temperature or position and was somewhat tender. Livedo reticularis was confirmed by biopsy (see Figure 1).

Mottled, blotchy, reticulated skin without distinct borders

Skin looks mottled, blotchy, and reticulated without distinct borders. It has a network pattern and a bluish, reddish discoloration. It does not blanche. It may be more pronounced with cold weather.

Commonly found on arms, legs, hands, and feet. It occasionally presents on the trunk.

Livedo reticularis has many causes. It is thought to be due to spasms of the blood vessels or an abnormality of the local circulation. It may be a dermatologic clue to a serious medical underlying illness as lupus erythematosus. Disturbances of hormonal and autonomic regulatory mechanisms may also contribute to this condition. It seems to occur more in women than in men and usually in the 3rd decade of life. It is often idiopathic and benign.

Persistent, mottled, reddish-blue dermal streaks that do not blanche. Blood vessels are constricted or narrowed.

If there is systemic involvement with the diagnosis, individual symptoms should be treated. For example, rheumatoid symptoms will be treated with anti-inflammatory medication. There is no definitive treatment for skin involvement. However, bath PUVA is a therapeutic option with the possibility of some success.

Livedo reticularis can be a normal condition that is simply more obvious when a person is exposed to the cold; however, over time it may become permanent. In severe cases ulcers in the extremities may occur.

Exercise is the best remedy. Increased circulation helps to dilate the blood vessels throughout the body.

Give emotional support and guidance. Instruct patients regarding avoiding cold. Give patient options regarding camouflage therapy.

The "Clinical Snapshot" series provides a concise examination of a clinical presentation including history, treatment, patient education, and nursing measures. Using the format here, you are invited to submit your "Clinical Snapshot" to Dermatology Nursing.

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