Livedoid vasculitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Synonyms and keywords: Livedo reticularis; livedo vasculitis; livedoid vasculopathy; primary livedo reticularis; idiopathic livedo reticularis; vitiligo reticularis;Atrophie blanche;

Overview

Livedoid vasculitis is a vascular disorder mostly affecting women. It may be aggravated by exposure to cold and occurs most often in the lower extremities. It can also be associated with the presence of anti-cardiolipin antibodies (the Antiphospholipid syndrome).

Historical Perspective

The condition's name derives from the Latin livere meaning bluish.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

There are no life-threatening causes of livedoid vasculitis that may result in death or permanent disability if left treated within 24 hours.

Common Causes

Causes by Organ System

Cardiovascular Antithrombin III deficiency, arteriosclerosis, Buerger's disease, carbon dioxide arteriography, cholesterol emboli syndrome, hypercalcemia, peripheral arterial occlusive disease, vasculitis
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic Cutis marmorata telangiectatica congenita, dermal vascular occlusion, dermatomyositis, FILS syndrome, idiopathic livedo reticularis, polyarteritis nodosa, scleroderma, Sneddon-Champion syndrome, systemic lupus erythematosus, vasculitis
Drug Side Effect Amantadine, dextroamphetamine, gefitinib, interferon beta treatment, methylphenidate, rasagiline
Ear Nose Throat No underlying causes
Endocrine Graves hyperthyroidism, pheochromocytoma
Environmental No underlying causes
Gastroenterologic Pancreatitis
Genetic Cystathionine beta-synthase deficiency, Down syndrome, Ehlers-Danlos syndrome, familial primary cryofibrinogenemia, homocystinuria, oxalosis, plasminogen activator inhibitor-1 promoter homozygosity, protein C deficiency, prothrombin G20210A heterozygosity
Hematologic Anticardiolipin syndrome, antiphospholipid syndrome, antithrombin III deficiency, cryoglobulinemia, elevated fibrinopeptide A, factor V Leiden mutation, familial primary cryofibrinogenemia, Henoch-Schönlein purpura, increased plasminogen activator release, lupus anticoagulant, pernicious anemia, polycythaemia rubra vera, protein C deficiency, thrombocytosis
Iatrogenic Midline catheter
Infectious Disease Cytomegalovirus infection, Lyme disease, syphilis, tuberculosis
Musculoskeletal/Orthopedic Ehlers-Danlos syndrome, FILS syndrome, rheumatoid arthritis
Neurologic Anticardiolipin syndrome, antiphospholipid syndrome, mononeuritis multiplex, moyamoya disease, Sneddon-Champion syndrome
Nutritional/Metabolic Cystathionine beta-synthase deficiency, homocystinuria, hyperhomocysteinemia, primary hyperoxaluria
Obstetric/Gynecologic Anticardiolipin syndrome, antiphospholipid syndrome
Oncologic Lymphoma, metastatic breast carcinoma, pheochromocytoma, renal cell carcinoma
Ophthalmologic Cystathionine beta-synthase deficiency, homocystinuria
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Churg-Strauss syndrome, sarcoidosis, scleroderma, tuberculosis
Renal/Electrolyte Henoch-Schönlein purpura, hypercalcemia, renal cell carcinoma, systemic lupus erythematosus
Rheumatology/Immunology/Allergy Anticardiolipin syndrome, antiphospholipid syndrome, Buerger's disease, Churg-Strauss syndrome, cryoglobulinemia, dermatomyositis, FILS syndrome, Henoch-Schönlein purpura, IgM antiphosphatidylserine-prothrombin complex antibody, immune complex disease, increased plasminogen activator release, lupus anticoagulant, mixed connective tissue disease, plasminogen activator inhibitor-1 promoter homozygosity, polyarteritis nodosa, polyclonal IgM hypergammopathy, rheumatoid arthritis, sarcoidosis, scleroderma, Sjögren's syndrome, systemic lupus erythematosus, vasculitis
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Silicone implants

Causes in Alphabetical Order

Diagnosis

Physical Examination

Skin

Extremities

Treatment

Other than identifying and treating any underlying conditions in secondary livedo,[58] idiopathic livedo reticularis itself may improve with warming the legs, but once established the skin discolouration may become permanent.

References

  1. ↑ 1.0 1.1 Liel Y (2004). "Livedo reticularis: a rare manifestation of Graves hyperthyroidism associated with anticardiolipin antibodies". South Med J. 97 (6): 601–3. PMID 15255431.
  2. ↑ Gibbs MB, English JC, Zirwas MJ (2005). "Livedo reticularis: an update". J Am Acad Dermatol. 52 (6): 1009–19. doi:10.1016/j.jaad.2004.11.051. PMID 15928620.
  3. ↑ Salvado M, Hernández-Vara J (2014). "[Livedo reticularis secondary to amantadine in a patient with Parkinson disease]". Med Clin (Barc). 142 (4): 186. doi:10.1016/j.medcli.2013.06.022. PMID 24012443.
  4. ↑ Silva SB, Miot HA (2012). "Case for diagnosis". An Bras Dermatol. 87 (2): 319–21. PMID 22570045.
  5. ↑ Xu LY, Liu A, Kerr HA (2011). "Livedo reticularis from amantadine". Skinmed. 9 (5): 320–1. PMID 22165049.
  6. ↑ 6.0 6.1 6.2 6.3 Hairston BR, Davis MD, Pittelkow MR, Ahmed I (2006). "Livedoid vasculopathy: further evidence for procoagulant pathogenesis". Arch Dermatol. 142 (11): 1413–8. doi:10.1001/archderm.142.11.1413. PMID 17116831.
  7. ↑ Asherson RA, Cervera R (1993). "Antiphospholipid syndrome". J Invest Dermatol. 100 (1): 21S–27S. PMID 8423386.
  8. ↑ Gibson GE, Su WP, Pittelkow MR (1997). "Antiphospholipid syndrome and the skin". J Am Acad Dermatol. 36 (6 Pt 1): 970–82. PMID 9204065.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 Keller MS, Lee J, Webster GF (2008). "Livedoid thrombotic vasculopathy responding to doxycycline therapy". J Clin Aesthet Dermatol. 1 (4): 22–4. PMC 3016933. PMID 21212844.
  10. ↑ Takanashi T, Horigome R, Okuda Y, Nose M, Matsuda M, Ikeda S (2007). "Buerger's disease manifesting nodular erythema with livedo reticularis". Intern Med. 46 (21): 1815–9. PMID 17978541.
  11. ↑ Johnson PL, Neperud J, Arnold J, Thomas J (2011). "Livedo reticularis and bowel ischemia after carbon dioxide arteriography in a patient with CREST syndrome". J Vasc Interv Radiol. 22 (3): 395–9. doi:10.1016/j.jvir.2010.11.012. PMID 21277800.
  12. ↑ Kazmier FJ, Sheps SG, Bernatz PE, Sayre GP (1966). "Livedo reticularis and digital infarcts: a syndrome due to cholesterol emboli arising from atheromatous abdominal aortic aneurysms". Vasc Dis. 3 (1): 12–24. PMID 5903590.
  13. ↑ Stewart WM, Lauret P, Testart J, Thomine E, Boulliê MC, Leroy D (1977). "[Cutaneous cholesterol emboli (author's transl)]". Ann Dermatol Venereol. 104 (1): 5–8. PMID 843026.
  14. ↑ Bosco L, Peroni A, Schena D, Colato C, Girolomoni G (2011). "Cutaneous manifestations of Churg-Strauss syndrome: report of two cases and review of the literature". Clin Rheumatol. 30 (4): 573–80. doi:10.1007/s10067-010-1593-1. PMID 20949297.
  15. ↑ Namazi MR, Kerchner KR, Pichardo RO (2008). "Essential type II mixed cryoglobulinemia causing pyoderma gangrenosum-like ulcers". ScientificWorldJournal. 8: 228. doi:10.1100/tsw.2008.44. PMID 18335149.
  16. ↑ Altman AR, Tschen JA, Wolf JE (1984). "Cutis marmorata telangiectatica congenita: a case report". Pediatr Dermatol. 1 (3): 223–5. PMID 6494067.
  17. ↑ Del Giudice SM, Nydorf ED (1986). "Cutis marmorata telangiectatica congenita with multiple congenital anomalies". Arch Dermatol. 122 (9): 1060–1. PMID 3740886.
  18. ↑ Halbesleben, Jennifer J.; Cleveland, Mark G.; Stone, Mary Seabury (2010). "Diffuse Dermal Angiomatosis Arising in Cutis Marmorata Telangiectatica Congenita". Archives of Dermatology. 146 (11). doi:10.1001/archdermatol.2010.331. ISSN 0003-987X.
  19. ↑ Arslan F, Batirel A, Mert A, Ozer S (2012). "Cytomegalovirus (CMV)-related cutaneous necrotizing vasculitis: case report and literature review". Braz J Infect Dis. 16 (5): 482–5. doi:10.1016/j.bjid.2012.08.002. PMID 22975173.
  20. ↑ 20.0 20.1 Syed, Reema H.; Moore, Terry L. (2008). "Methylphenidate and Dextroamphetamine-Induced Peripheral Vasculopathy". JCR: Journal of Clinical Rheumatology. 14 (1): 30–33. doi:10.1097/RHU.0b013e3181639aaa. ISSN 1076-1608.
  21. ↑ Bilgili SG, Akdeniz N, Karadag AS, Akbayram S, Calka O, Ozkol HU (2011). "Mucocutaneous disorders in children with down syndrome: case-controlled study". Genet Couns. 22 (4): 385–92. PMID 22303799.
  22. ↑ Daneshpazhooh M, Nazemi TM, Bigdeloo L, Yoosefi M (2007). "Mucocutaneous findings in 100 children with Down syndrome". Pediatr Dermatol. 24 (3): 317–20. doi:10.1111/j.1525-1470.2007.00412.x. PMID 17542890.
  23. ↑ Yong AA, Tan AW, Giam YC, Tang MB (2012). "Livedoid vasculopathy and its association with factor V Leiden mutation". Singapore Med J. 53 (12): e258–60. PMID 23268168? Check |pmid= value (help).
  24. ↑ van Geest AJ, van Dooren-Greebe RJ, Andriessen MP, Blomjous CE, Go IH (1999). "Familial primary cryofibrinogenemia". J Eur Acad Dermatol Venereol. 12 (1): 47–50. PMID 10188150? Check |pmid= value (help).
  25. ↑ Pachlopnik Schmid J, Lemoine R, Nehme N, Cormier-Daire V, Revy P, Debeurme F; et al. (2012). "Polymerase ε1 mutation in a human syndrome with facial dysmorphism, immunodeficiency, livedo, and short stature ("FILS syndrome")". J Exp Med. 209 (13): 2323–30. doi:10.1084/jem.20121303. PMC 3526359. PMID 23230001.
  26. ↑ Blume JE, Miller CC (2007). "Livedo reticularis with retiform purpura associated with gefitinib (Iressa)". Int J Dermatol. 46 (12): 1307–8. doi:10.1111/j.1365-4632.2007.03319.x. PMID 18173531.
  27. ↑ Helander SD, De Castro FR, Gibson LE (1995). "Henoch-Schönlein purpura: clinicopathologic correlation of cutaneous vascular IgA deposits and the relationship to leukocytoclastic vasculitis". Acta Derm Venereol. 75 (2): 125–9. PMID 7604640.
  28. ↑ Tabata N, Oonami K, Ishibashi M, Yamazaki M (2010). "Livedo vasculopathy associated with IgM anti-phosphatidylserine-prothrombin complex antibody". Acta Derm Venereol. 90 (3): 313–4. doi:10.2340/00015555-0835. PMID 20526560.
  29. ↑ Fox M, Tahan S, Kim CC (2012). "Livedo reticularis: a side effect of interferon therapy in a pediatric patient with melanoma". Pediatr Dermatol. 29 (3): 333–5. doi:10.1111/j.1525-1470.2011.01426.x. PMID 21575046.
  30. ↑ Cruz BA, Queiroz ED, Nunes SV, Cruz Filho A, Campos GB, Monteiro EL; et al. (2000). "[Severe Raynaud's phenomenon associated with interferon-beta therapy for multiple sclerosis: case report]". Arq Neuropsiquiatr. 58 (2B): 556–9. PMID 10920422.
  31. ↑ Rot U, Ledinek AH (2013). "Interferons beta have vasoconstrictive and procoagulant effects: a woman who developed livedo reticularis and Raynaud phenomenon in association with interferon beta treatment for multiple sclerosis". Clin Neurol Neurosurg. 115 Suppl 1: S79–81. doi:10.1016/j.clineuro.2013.09.027. PMID 24321162.
  32. ↑ Stephansson EA, Niemi KM, Jouhikainen T, Vaarala O, Palosuo T (1991). "Lupus anticoagulant and the skin. A longterm follow-up study of SLE patients with special reference to histopathological findings". Acta Derm Venereol. 71 (5): 416–22. PMID 1684471.
  33. ↑ Gambichler T, Baier P, Altmeyer P (2009). "Generalized livedo reticularis as the first sign of metastatic breast carcinoma". Clin Exp Dermatol. 34 (2): 253–4. doi:10.1111/j.1365-2230.2008.02801.x. PMID 19120398.
  34. ↑ Shrestha NK, Gordon SM, Isada CM (2002). "Livedo reticularis associated with the use of a midline catheter". Scand J Infect Dis. 34 (11): 845–6. PMID 12578157.
  35. ↑ Oh YB, Jun JB, Kim CK, Lee CW, Park CK, Kim TY; et al. (2000). "Mixed connective tissue disease associated with skin defects of livedoid vasculitis". Clin Rheumatol. 19 (5): 381–4. PMID 11055828.
  36. ↑ Toth C, Trotter M, Clark A, Zochodne D (2003). "Mononeuropathy multiplex in association with livedoid vasculitis". Muscle Nerve. 28 (5): 634–9. doi:10.1002/mus.10450. PMID 14571469.
  37. ↑ Richards KA, Paller AS (2003). "Livedo reticularis in a child with moyamoya disease". Pediatr Dermatol. 20 (2): 124–7. PMID 12657007.
  38. ↑ Jorquera-Barquero E, Súarez-Marrero MC, Fernández Girón F, Borrero Martín JJ (2013). "Oxalosis and livedo reticularis". Actas Dermosifiliogr. 104 (9): 815–8. doi:10.1016/j.ad.2012.04.019. PMID 23103120.
  39. ↑ Gould JW, Helms SE, Schulz SM, Stevens SR (1998). "Relapsing livedo reticularis in the setting of chronic pancreatitis". J Am Acad Dermatol. 39 (6): 1035–6. PMID 9843029.
  40. ↑ SIGMUND WJ, SHELLEY WB (1954). "Cutaneous manifestations of acute pancreatitis, with special reference to livedo reticularis". N Engl J Med. 251 (21): 851–3. doi:10.1056/NEJM195411182512104. PMID 13214346.
  41. ↑ Sevastos NS, Rafailidis PI, Katoulis AC, Kolokotronis KG, Stavrianeas NG (2003). "Livedo reticularis associated with pernicious anaemia". Clin Exp Dermatol. 28 (4): 452–3. PMID 12823317.
  42. ↑ Buckley, Sarah A.; Lessing, Juan N.; Mark, Nicholas M. (2013). "Livedo Reticularis in a Patient With Pheochromocytoma Resolving After Adrenalectomy". The Journal of Clinical Endocrinology & Metabolism. 98 (2): 439–440. doi:10.1210/jc.2012-2842. ISSN 0021-972X.
  43. ↑ 43.0 43.1 Antunes J, Filipe P, André M, Fraga A, Miltenyi G, Marques Gomes M (2010). "Livedoid vasculopathy associated with plasminogen activator inhibitor-1 promoter homozygosity (4G/4G) and prothrombin G20210A heterozygosity: response to t-PA therapy". Acta Derm Venereol. 90 (1): 91–2. doi:10.2340/00015555-0760. PMID 20107738.
  44. ↑ Llamas-Velasco M, de Argila D, Fraga J, García-Diez A (2011). "[Cutaneous polyarteritis nodosa with manifestations of livedoid vasculopathy]". Actas Dermosifiliogr. 102 (6): 477–9. doi:10.1016/j.ad.2010.10.020. PMID 21477790.
  45. ↑ Morgan AJ, Schwartz RA (2010). "Cutaneous polyarteritis nodosa: a comprehensive review". Int J Dermatol. 49 (7): 750–6. doi:10.1111/j.1365-4632.2010.04522.x. PMID 20618492.
  46. ↑ Endo Y, Miyachi Y, Yoshikawa Y (2011). "Idiopathic livedo reticularis concomitant with polyclonal IgM hypergammopathy". Eur J Dermatol. 21 (2): 266–7. doi:10.1684/ejd.2010.1226. PMID 21489905.
  47. ↑ Bogle MA, Teller CF, Tschen JA, Smith CA, Wang A (2003). "Primary hyperoxaluria in a 27-year-old woman". J Am Acad Dermatol. 49 (4): 725–8. PMID 14512927.
  48. ↑ Marconi V, Mofid MZ, McCall C, Eckman I, Nousari HC (2002). "Primary hyperoxaluria: report of a patient with livedo reticularis and digital infarcts". J Am Acad Dermatol. 46 (2 Suppl Case Reports): S16–8. PMID 11807460.
  49. ↑ Shih HA, Kao DM, Elenitsas R, Leyden JJ (2000). "Livedo reticularis, ulcers, and peripheral gangrene: cutaneous manifestations of primary hyperoxaluria". Arch Dermatol. 136 (10): 1272–4. PMID 11030785.
  50. ↑ Singh S, Tai C, Ganz G, Yeung CK, Magil A, Rosenberg F; et al. (1999). "Steroid-responsive pleuropericarditis and livedo reticularis in an unusual case of adult-onset primary hyperoxaluria". Am J Kidney Dis. 33 (4): e5. PMID 10196036.
  51. ↑ Boyvat A, Kundakçi N, Babikir MO, Gürgey E (2000). "Livedoid vasculopathy associated with heterozygous protein C deficiency". Br J Dermatol. 143 (4): 840–2. PMID 11069468.
  52. ↑ Strowd LC, Lee AD, Yosipovitch G (2012). "Livedo reticularis associated with rasagiline (azilect)". J Drugs Dermatol. 11 (6): 764–5. PMID 22648227.
  53. ↑ Erel A, Ozsoy E, University G (2001). "Livedo reticularis associated with renal cell carcinoma". Int J Dermatol. 40 (4): 299–300. PMID 11454094.
  54. ↑ 54.0 54.1 Takenoshita H, Yamamoto T (2010). "Erythema nodosum-like cutaneous lesions of sarcoidosis showing livedoid changes in a patient with sarcoidosis and Sjögren's syndrome". Eur J Dermatol. 20 (5): 640–1. doi:10.1684/ejd.2010.1034. PMID 20610374.
  55. ↑ Thomas JR, Winkelmann RK (1983). "Vascular ulcers in scleroderma". Arch Dermatol. 119 (10): 803–7. PMID 6137196.
  56. ↑ Camacho D, Machan S, Pilesanski U, Revelles JM, Martín L, Requena L (2012). "Generalized livedo reticularis induced by silicone implants for soft tissue augmentation". Am J Dermatopathol. 34 (2): 203–7. doi:10.1097/DAD.0b013e31821cb3c5. PMID 22441370.
  57. ↑ Yasue T (1986). "Livedoid vasculitis and central nervous system involvement in systemic lupus erythematosus". Arch Dermatol. 122 (1): 66–70. PMID 3942409.
  58. ↑ Fleischer A, Resnick S (1990). "Livedo reticularis". Dermatol Clin. 8 (2): 347–54. PMID 2191805.


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