Livedo reticularis is a type of skin condition that is characterized by purplish discoloration of skin, which occurs in patches. The parts of the body which are commonly affected are hands, arms, legs and feet.
Signs and symptoms of livedo reticualris significantly vary with the underlying causative factor. Development of rash mainly on the lower extremities is the major symptom of livedo reticularis. The rash develops in a net like pattern with mesh size less than 3 cm. The rash is purplish to reddish blue in color which no distinct border and does not itch. The joint of the affected leg or hand undergoes swelling and is painful. In many cases, this may be accompanied by tingling or numbness in the area. When left untreated, ulcers may develop at the site .
Diagnosis of livedo reticularis would depend on obtaining information about secondary ulceration, subcutaneous nodules and retiform purpura. A past medical history of the patient should be carefully noted. This would provide insight of underlying diseases if any. Following this, a detailed drug profile should also be taken. Physical examination of the characteristics of the rash is carried out. If the patient is suffering from fever, then it may be an indication of infection as the cause of livedo reticularis.
Laboratory tests such as complete blood count, proteinuria, kidney function tests, coagulation studies, antinuclear antibodies, antiphospholipid antibodies, antineutrophil cytoplasmic antibodies along with hepatitis B and C serology would be done. Skin biopsy confirms the condition of livedo reticularis.
Treatment depends on treating the underlying disease condition and effective management of symptoms. Exercise such as leg elevation and ankle pumping helps in establishing appropriate blood circulation thereby relieving the constriction in blood vessels. Application of warm therapy to the affected area can also help. Individuals are advised against application of ice or any coolant to the area.
Antiinflammatory medications are administered if rheumatoid arthritis is the cause. Skin lesions are treated with low dose aspirin. Anticoagulant therapy and antiplatelet therapy are also indicated . Another mode of treatment that is also quite effective in treatment of livedo reticularis is PUVA therapy .
Livedo reticularis occurs due to spasms in the blood vessels. Or it may also occur due to abnormality that occurs in the circulation near the surface of the skin. In many instances, extreme cold weather conditions can trigger an attack of livedo reticualris. However, it can also indicate the development of some serious underlying disease conditions, which include vascular disease, rheumatologic disease and endocrine disorders. Livedo reticularis can also occur as a side effect of certain medications such as amantadine given for treatment of Parkinson disease . In rare cases, it can also occur as a secondary complication to dialysis; a condition known as calciphylaxis .
Livedo reticularis is a common occurrence amongst the female population. Patients suffering from antiphospholipid syndrome are at an increased risk of developing the skin condition. The condition was first described in the year 1970 by Shealy et al. It was estimated that, amantadine-induced livedo reticualris was prevalent in 2 to 28% of patients .
Livedo reticularis can be divided into 4 different categories based on the appearance of livedo and the underlying etiology. These include physiologic, primary, idiopathic, and amantadine-induced livedo reticularis. The primary form majorly strikes young women and affects the lower extremities. It gets exaggerated due to cold weather and gradually resolves on re-warming. The condition is also otherwise known as cutis marmorata.
The basic physiologic changes that take place for skin discoloration and mottling are due to contractions of blood vessels. Such an event restricts the blood supply to the affected area causing purplish or reddish blue discoloration of skin. The skin looks mottled and has a net-like pattern, which primarily occurs due to stagnation of deoxygenated blood.
In primary form, the change in skin color is not related to temperatures. Idiopathic livedo reticularis does not resolve and is a persistent form of skin condition. This may be an important marker for early stage of Sneddon’s syndrome. The condition may also occur as a secondary phenomenon to antiphospholipid syndrome and livedo vasculitis  .
Amantadine-induced livedo reticularis, as the name suggest occurs due to side effect of the medication amantadine which is used for treatment and management of diseases such as Parkinson disease and multiple sclerosis.
Livedo reticularis may occur in healthy individuals or may even strike those who are suffering from underlying disease conditions. Lower extremities are affected the most. The condition gets severe in cold weather conditions. Discoloration of the skin primarily occurs due to swelling of the venules due to contractions. In such a type of condition, the skin assumes a net-like appearance with distinct borders and becomes mottled .