Livedo reticularis

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  Livedo reticularis

  Idiopathic livedo reticularis occurs mostly in women as symmetric diffuse mottling on cold exposure, sometimes accompanied by numbness and tingling. The discoloration is persistent and may change from reddish blue in a warm environment to a deep blue in a cold environment.

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  Ulceration

  Two variants of livedo reticularis with ulceration have also been described: one with ulceration in the winter and one with edema of the ankles and ulceration in the spring and summer.

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  Ulceration

  Ulcers are small but painful and heal with atrophic-pigmented scars. Skin biopsies have shown fibrinoid necrosis of small blood vessels, hyaline thrombi and mild perivascular lymphocytic infiltrates. Treatment involves advising the patient to avoid the cold and treating the primary condition.

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  Diffuse mottling

  Venous drainage at the margins of areas of the skin richly supplied by arterial cones is believed to cause the netlike pattern. When factors, including cold, arteriolar disease and blood hyperviscosity, reduce blood flow rates in the superficial venous plexus, the cyanotic reticular pattern becomes more pronounced.