Livedo

LIVEDO (from Latin lividus-crimson), more correctly lividitas, is a form of passive skin hyperemia manifesting as a network of bluish-purple discoloration with loops of various outlines and sizes that fluctuates in shades and temporarily disappears upon pressure. The following clinical types are described. 1) Livedo racemosa (Ehrmann)—persistent tree-like reticular figures on the skin, mainly on the limbs, less frequently on the trunk, very often passing without sharp boundaries into the ramifications of cutis marmorata. In some cases, this is a purely functional vasomotor disorder of mixed etiology (various acute or chronic infections, especially syphilis and tuberculosis, or intoxications, endocrine gland dysfunction, weakened cardiac activity, nephrosis-nephritis, etc.); in others, it is connected with anatomical changes in the walls of the arterial and venous network of the skin and subcutaneous tissue and capillaries. The disease does not trouble patients and lasts for a long time; massage, warm baths, diathermy, and ultraviolet rays are recommended for treatment; if the disease develops on the basis of syphilis, significant improvement may occur under the influence of specific treatment. 2) Livedo reticularis. Ehrmann identifies it with livedo racemosa; other authors separate it from livedo racemosa, attributing its origin to external causes, mainly the prolonged action of heat (thermophores, hot compresses, heating pads, etc.). Clinically, there is first (stage I, hyperemic) a persistent reticular hyperemic coloration, which gradually loses its redness (stage II, pigmentary), assumes a brownish hue that becomes increasingly dense under the thickened epidermis (stage III, hyperplastic). Histologically: around the vessels of the papillary layer, there is an inflammatory infiltrate of mononuclear and multinuclear and plasma cells; single chromatophores and freely lying iron-containing pigment; the amount of pigment is increased in the basal layer and in the interepithelial spaces. 3) Livedo-like and telangiectatic syphilide. Under this name, E. Hoffmann described Brocq's essential telangiectasias observed in syphilitics in the form of diffuse or sharply demarcated spots composed of numerous thin branching vessels. 4) Livedo annularis (synonyms: cutis marmorata, livedo a frigore); on bloodless skin, a continuous net-like pink-violet coloration of the skin with rounded or oval loops, occurring upon cooling of the body, especially pronounced on the extensor sides of the limbs and buttocks, and disappearing without a trace at high air temperatures. It is regarded as an intensification of the physiological vascular reaction of the skin to cooling. 5) Adamson's livedo lenticularis—reticular marhorescence of the skin, appearing mainly on the shins as the initial form of Bazin's indurated erythema.