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Livedo

Livedo is a persistent bluish color, uneven dyeing of the skin, resulting from vascularization through the skin of vessels with passive hyperemia.


Livedo racemosa

There are several types: 1) Livedo racemosa - the result of functional or anatomical changes in skin vessels, resulting from chronic infections ( syphilis , tuberculosis ) or intoxication. It is characterized by the appearance on the skin of limbs of persistent bluish-colored tree-net spots, which disappear under pressure. There are no subjective sensations. In cold wet weather, the spots are more pronounced, often combined with acrocyanosis. Sometimes a livedo can be a symptom of periarteritis nodosa; 2) Livedo reticularis a calore - mesh erythema , which occurs under the influence of external causes (hot compresses, heaters); skin color gradually takes on a brown tint as a result of hemo-siderol deposits 3) Livedo reticularis a frigore - the result of individual hypersensitivity of the vessels to cold; appears as a reticular pink-purple staining on bloodless skin, especially expressed on the extensor surfaces of the limbs when the body cools; when the air temperature rises, these phenomena disappear; 4) Livedo lenticularis - mesh marbling of the skin of the legs - the initial stage of Bazin's erythema (see Skin Tuberculosis ).

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Treatment : massage , warm baths, diathermy, UV irradiation; with Livedo racemosa - treatment of chronic infections, intoxications.

Livedo (from the Latin. Lividus - bluish-gray) - bluish, uneven dyeing of the skin of a reticular or tree-like pattern, resulting from blood vessels through the skin, due to passive hyperemia.

Clinical varieties . 1. Livedo reticularis [synonym: L. annularis, cutis marmorata (marbled skin), L. marmorata, asphyxia reticularis] - unstable, pink-purple or pale bluish, limited or widespread, disappearing under pressure of a grid-shaped spot with oval round loops or in the form of densely arranged, merging, various sizes of circles. In the center of the loop skin color is paler than normal. It is observed more often in girls and young women. Located symmetrically on the extensor surface often lower limbs, the lateral surface of the body; not accompanied by any sensations. L. reticularis usually occurs as a result of long-lasting action on the skin of low temperature (L. reticularis a frigore) in case of functional insufficiency of the skin vessels; morphological changes of vessels are absent. It occurs in childhood, in the period of sexual development increases, then weakens. It is often combined with acrocyanosis, chills, hyperhidrosis, and keratinization (keratosis pilaris).

There is a form of livedo reticularis caused by prolonged exposure to heat (L. reticularis a calore). In this form, transient and then persistent reddenings appear at the beginning, leaving behind a reticular skin pigmentation, the so-called reticular dermatitis (cutis marmorata pigmentosa, A. Buschke).

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2. Livedo racemosa (S. Ehrmann) is a rare skin lesion that manifests itself as persistent, tree-like branching bluish-red spots of various sizes. These spots do not peel, for a number of years remain unchanged and do not disappear from the heat. Rarely, spontaneous necrosis of the skin occurs in the L. racemosa zone, leading to ulceration. It is observed almost exclusively in women. It is located on the skin of the shoulders, thighs, buttocks, less often on the skin of the body.

Histopathology: inflammatory changes in the walls of arterioles and small veins of the skin and subcutaneous tissue (intimal proliferation, sometimes leading to obliteration of the lumen of the vessels, perivascular infiltration), puffiness, fibrinoid swelling of collagen fibers, and later dermis fibrosis. In addition to the skin, the corresponding vascular changes can develop in the muscle tissue.

The etiology often remains unexplained. L. racemosa can develop with syphilis (usually in the tertiary period and late congenital), tuberculosis, typhus, dysentery, malaria, rheumatic arthritis, chronic intoxication (alcoholism), tumors, dysfunction of the endocrine glands, systemic lupus erythematosus, anomalies, tumors, dysfunction of the endocrine glands, systemic lupus erythematosus, adrenal gland, dysfunction of the endocrine glands, systemic lupus erythematosus, adrenal glandular disorder, anorectal glandular dysfunction erythema, atrophic acrodermatitis. Predisposing conditions for the development of L. racemosa, apparently, are congenital or acquired, organic or functional disorders of the cardiovascular system, in particular the change in the tone of peripheral vessels (heart defects, hypotension, arteriosclerosis). It differs from L. reticularis L. racemosa by its firmness and the shape of spots that do not disappear from heat, more often by the limited nature of the skin lesion. Roseoletic syphilide in the resolution stage from L. racemosa is distinguished by a regular oval-rounded shape of spots, their abundance, symmetry. It is necessary to differentiate L. racemosa from congenital limited and widespread essential telangiectasias (a kind of vascular nevus).
3. Livedo lenticularis - mesh marbling of the skin of the legs, the initial stage of Bazin's indurative erythema (see Skin Tuberculosis). It is histologically characterized by endophlebitis.

Treatment . Restorative remedies - vitamins C, P, PP, calcium preparations, skin irradiation with sub-arythemic doses of ultraviolet rays, warm baths, diathermy, massage. In case of L. racemosa, according to indications, specific antisyphilitic, anti-tuberculosis treatment is carried out; in acute cases of unclear etiology, some improvement can be achieved with corticosteroids.