EpistemisLivedo reticularis
Specialty: Skin.
Why it occurs
- Physiological or cold-induced livedo reticularis (cutis marmorata, reversible upon rewarming)
- Antiphospholipid syndrome (non-inflammatory obstructive microvascular thrombosis)
- Systemic lupus erythematosus or polyarteritis nodosa (vasculitis of medium-caliber vessels that alters the flow of the dermal arteriolar plexuses)
- Cryoglobulinemia (precipitation of plasma proteins due to cold with capillary obstruction)
- Cholesterol crystal embolism (secondary to catheterization or recent anticoagulation).
Initial workup
Complete coagulation profile that includes activated partial thromboplastin time (aPTT), lupus anticoagulant, anticardiolipin antibodies (IgG and IgM), anti-beta-2-glycoprotein I antibodies. Serum cryoglobulins, complete blood count, autoimmunity profile (ANA, anti-DNA, ANCA) and deep skin biopsy (including subcutaneous tissue) of the pale edges of the lesion.
red flags
Presence of an irregular and asymmetric livedoid pattern that does not reverse with heat (livedo racemosa), presence of superimposed painful necrotic ulcers, paresthesias or motor weakness in the affected limb, or history of recurrent pregnancy loss or previous thrombotic events.
Standard management
- Acetylsalicylic acid at low doses — antiplatelet agent to prevent microvascular occlusion, 100 mg/day
- Low molecular weight heparin such as enoxaparin — indicated if antiphospholipid syndrome with active thrombosis is confirmed
- Pentoxifylline — hemorheological agent that reduces blood viscosity and improves microcirculation
- Treat the cold stimulus through strict physical measures to preserve body temperature.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4