Livedo reticularis

Classification according to ICD-10
R23.1	Other skin changes - pallor
I73.83	Other specified peripheral vascular diseases
ICD-10 online (WHO version 2019)

The livedo reticularis , from Latin lividus 'bluish' and Latin reticularis 'reticular' , is a disorder of the skin circulation that occurs when hypothermia occurs with the appearance of reticulated blue-red stripes "cold marbling" or ring-shaped cyanosis around a pale center, usually on the lower legs .

Synonyms are: Cutis marmorata; Marble skin; Livedo anularis; Cold marbling

The phenomenon should not be confused with scarring livedovasculopathy .

Spread and cause

The frequency is not known. As a rule, it is a harmless, functional, temperature-dependent disruption of the skin circulation with slowing of the flow and lack of oxygen and the resulting skin changes. The trigger is usually exposure to cold, less often exposure to heat (erythema e calore).

This change occurs regularly in the first few weeks of life with a slight cooling and in young (mostly female) adults. Women between the ages of 20 and 50 are more often affected.

Livedo reticularis can also be an indication of trisomy 18 , Down syndrome , Cornelia de Lange syndrome or hypothyroidism .

The cutis marmorata can also appear as an essential feature in some syndromes :

Secondary forms

It can appear as a side effect (secondary) in the following diseases:

Antiphospholipid Syndrome
Hepatitis C.
Collagenosis such as systemic lupus erythematosus
Complex regional pain syndrome (Sudek dystrophy)
Cryoglobulinemia
Paraproteinemia
Polyarteritis nodosa
Polyglobules
Rheumatoid arthritis
tuberculosis

also as a side effect of drugs such as amantadine , erythromycin , heparin , interferons and memantine

Clinical manifestations

Clinical criteria are:

Temperature-dependent skin changes mostly on the hands , feet , forearms and lower legs
reticulated to ring-shaped skin markings with red marginal zones

Differential diagnostics

A distinction should be made between acrocyanosis and livedo racemosa as well as centrally caused disorders such as stroke or traumatic brain injury .

literature

K. Sharma, A. Patel: Livedo Reticularis in Cold Agglutinin Disease. In: The New England Journal of Medicine . Volume 381, number 13, September 2019, p. E27, doi: 10.1056 / NEJMicm1902289 , PMID 31553839 .
A. Alnami, N. Alkhayal, R. Alkhodair: A rare manifestation of systemic sarcoidosis with livedo reticularis-like eruption in a pediatric patient: A case report. In: JAAD case reports. Volume 5, number 4, April 2019, pp. 392-394, doi: 10.1016 / j.jdcr.2019.02.012 , PMID 31008178 , PMC 6454130 (free full text).

Individual evidence

↑ Willibald Pschyrembel : Clinical Dictionary , 266th, updated edition, de Gruyter, Berlin 2014, ISBN 978-3-11-033997-0, keyword Livedo
↑ ^a ^b ^c ^d Entry on Cutis_marmorata in Flexikon , a wiki of the DocCheck company

↑ ^a ^b ^c ^d ^e ^f ^g Encyclopedia Dermatology

↑ ^a ^b Medline Plus

↑ Megalencephaly-capillary malformations-polymicrogyria syndrome. In: Orphanet (Rare Disease Database).

↑ Encyclopedia Dermatology

↑ KJ Helmandollar, KR Hoverson, JH Meyerle: Amantadine-induced livedo reticularis in a child Treated off label for neurobehavioral disorders. In: Cutis. Volume 102, Number 3, September 2018, pp. E8-E9, PMID 30372725 .

[1] Willibald Pschyrembel : Clinical Dictionary , 266th, updated edition, de Gruyter, Berlin 2014, ISBN 978-3-11-033997-0, keyword Livedo

[flexikon-2] Entry on Cutis_marmorata in Flexikon , a wiki of the DocCheck company

[Altmeyer-3] ↑ ^a ^b ^c ^d ^e ^f ^g Encyclopedia Dermatology

[Medline-4] Medline Plus

[5] Megalencephaly-capillary malformations-polymicrogyria syndrome. In: Orphanet (Rare Disease Database).

[6] Encyclopedia Dermatology

[7] KJ Helmandollar, KR Hoverson, JH Meyerle: Amantadine-induced livedo reticularis in a child Treated off label for neurobehavioral disorders. In: Cutis. Volume 102, Number 3, September 2018, pp. E8-E9, PMID 30372725 .