What You Should Know About Livedo Reticularis

Livedo reticularis (LR) is a type of skin discoloration that can occur if there is an interruption of blood flow to the skin. This is often a temporary, harmless phenomenon that is the result of exposure to cold temperatures or stress. It can also appear because of several serious underlying conditions.

Skin affected by livedo reticularis usually has reddish-purplish discoloration with a web-like or mottled pattern that forms circles on the legs or arms. This can differ depending on the cause, however.

Because livedo reticularis more frequently impacts babies and assigned females between the ages of 20 and 50, such skin discoloration in others—particularly without cold temperature exposure or stress—may be the first indication that a medical evaluation is needed.

This article explains the causes and symptoms of livedo reticularis, as well as how it is diagnosed and treated. It also discusses in what cases you should worry about livedo reticularis and contact your healthcare provider.

Causes of Livedo Reticularis

Livedo reticularis is usually divided into two categories based on its cause:

• Physiologic livedo reticularis, or primary LR, is considered normal and can be triggered by cold weather or stress.
• Pathological livedo reticularis, which is also called secondary LR or livedo racemosa, is related to an underlying health condition, such as diabetes, infection, or an autoimmune disorder.

Physiologic Livedo Reticularis

Physiologic livedo reticularis is a phenomenon seen quite commonly in people who have no underlying medical conditions and is usually considered a variant of normal.

Exposure to cold, and sometimes stress, can cause some of the arterioles, or small arteries, that supply the skin to constrict. This leads to reduced blood supply to the skin. The center of the patch of skin supplied by this constricted artery becomes pale and the blood trapped in the tiny blood vessels along the perimeter of the area becomes purplish in color (because it is deoxygenated). The result is a circular, web-like pattern of purplish discoloration with a pale center.

It is common for this condition to lead to a large network of these circular discolorations on the skin. When the skin warms up or stress is reduced, the constricted arterioles open up and the livedo reticularis disappears. 

Pathological Livedo Reticularis

Pathological livedo reticularis is also caused by a blockage of the penetrating arterioles that supply the skin tissue. But here, the blockage is caused by something other than a physiological constriction of the blood vessel, and depending on the underlying cause, the rash may be permanent. 

Pathological livedo reticularis can be a symptom of numerous medical conditions, including:

• Autoimmune disorders, such as lupus or antiphospholipid syndrome
• Cryoglobulinemia
• Cryofibrinogenemia
• Cold agglutinin disease
• Polycythemia vera
• Deep venous thrombosis
• Thrombotic thrombocytopenic purpura
• Sneddon syndrome
• Hemolytic uremic syndrome
• Numerous types of vascuilitis
• Cancers
• Dermatomyositis
• Various infections
• Diabetes
• Cholesterol emboli
• Parkinson’s disease
• Brain injury

Livedo Reticularis Symptoms

With physiologic livedo reticularis, the only symptom is a reddish-purplish skin discoloration that:

• Is web-like
• Forms numerous circular patterns on the skin
• Is most common on the arms and legs
• Has circular formations that tend to be complete with some broken segments
• Has pale centers within the circles
• Has no lumps or bumps, or associated pain

With pathological livedo reticularis, the symptoms may be identical to those seen with physiologic livedo reticularis. However, when livedo reticularis is caused by a serious underlying medical problem, the pattern of discoloration is often atypical and:

• The color of the affected skin is often strikingly violet.
• It is more likely to form a highly irregular pattern of broken circles.
• Skin changes may be more widespread, and in addition to the arms and legs, appear on the trunk and buttocks, and may even become generalized.
• A painful nodule or an ulcer may be present in the center of the circular patterns.
• The skin discoloration tends to be permanent.
• It is often not noticeably associated with cold temperatures.

When to See a Healthcare Provider

You should see a healthcare provider if you have any of the signs or symptoms of livedo reticularis. This is especially important if:

• Warming up your skin or reducing stress doesn't help the skin discoloration at all
• You have painful lumps
• You have a known underlying health condition
  

Diagnosis

The diagnosis of livedo reticularis itself is usually straightforward, given the distinctive appearance of this condition and the typical circumstances in which it occurs. In the vast majority of cases, livedo reticularis is a normal phenomenon, and no additional testing is needed.

Livedo Reticularis Differential Diagnosis

The diagnosis can become challenging if the skin discoloration, or the circumstances in which it appears, suggest a pathological cause. In these cases, the doctor will begin with a thorough medical history and physical examination.

Targeted diagnostic testing may be done to look for the suspected underlying condition.

If the initial evaluation does not point in a particular direction, the doctor may also order:

• Screening blood tests, such as a complete blood count and a metabolic panel
• Blood tests that screen for cold agglutinins, antiphospholipids, cryoglobulins, cryofibrinogens, autoimmune disease, and coagulation disorders
• A computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan, if cancer is suspected
• A skin biopsy

Livedo Reticularis Treatment

Physiologic livedo reticularis is a normal, passing phenomenon that has no known medical consequences. Aside from warming up the skin or reducing stress, physiologic livedo reticularis is not something to worry about and no treatment is required.

Because the underlying medical conditions associated with pathological livedo reticularis tend to be serious and potentially life-threatening, treatment should be aimed at addressing the underlying cause, once confirmed.

A Word From Verywell

Livedo reticularis is most typically a common, benign, and transient skin discoloration associated with cold exposure or stress. In some cases, however, livedo reticularis is caused by a serious underlying medical problem. The pattern of the discoloration and the circumstances in which it occurs should provide the doctor with important clues as to whether livedo reticularis requires a full medical evaluation, or merely reassurance.