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Livedo reticularis - when skin appears mottled

Skin Conditions, Immune | November 18, 2020 | Author: Naturopath

Skin conditions, autoimmune

Livedo reticularis - when skin appears mottled

Some people, when cold, can experience a mottled effect on their skin of varying degrees of red, blue or purple colour. The appearance is that of a net-like pattern with distinct edges, occurring particularly on the legs and resolving when the area becomes warm. This anomaly is usually benign, but it can also be a symptom of more serious health concerns - such as vascular disease, autoimmune disease or a reaction to medication.

Blotchy skin with a net-like pattern coloured in a purple/reddish-blue is a characteristic of a condition known as Livedo reticularis (LR). Its appearance is mainly seen on the legs and is often worse in colder temperatures. This condition occurs due to spasms or an abnormality in venous blood circulation.

Primary and Secondary Livedo reticularis

Livedo reticularis

The skin discoloration pattern of LR is a result from veins in the skin that are filled with more blood than normal causing enlarged veins or blocked blood flow leaving the veins.

The diagnosis of LR can be based on the duration, livedo pattern and temperature association.

Physiological LR, also known as cutis marmorata, occurs commonly on the legs of young women on exposure to cold temperature and resolves on warming. The mottling effect is considered an impairment of blood flow in the vessels of otherwise normal skin.

Idiopathic LR is persistent and non-resolving with diagnosis reached when no other pathological signs are found.

Amantadine-induced LP (amantadine is a prescription drug prescribed to treat disorders of movement caused by Parkinson’s disease, drug-induced movement disorders, and influenza A viral infection.

Livedo reticularis can be seen as primary (livedo reticularis) or secondary disorder known as livedo racemosa (LRC).

Livedo racemosa

Livedo racemosa (LRC) appearance is similar to that of LR but differential diagnosis is obtained by its location (generalized and wide-spread – found on limbs, trunk and buttocks), and its shape (irregular, broken pattern with circular segments) and through biopsy.

When it's not just the cold

The occurrence of livedo reticularis may be due to many other reasons. These might include:

  • Congenital - present at birth
  • Reaction to medication
  • Associated with other blood vessel disorders such as - Raynaud phenomenon or polyarteritis nodosa
  • Paralysis
  • Infections - such as hepatitis C
  • Autoimmune associated – Antiphospholipid syndrome (APS) an autoimmune disorder where the body's immune system makes antibodies which attack phospholipids; Systemic lupus erythematosus (SLE) - a chronic autoimmune disease characterised by multi-system manifestations; Connective tissue disease collection of diseases that affect the parts of your body that hold internal structures together
  • Sneddon’s syndrome - a rare, progressive condition that affects blood vessels
  • Endocrine disorders – hypothyroidism
  • Erythema ab igne - also known as hot water bottle rash, is a heat-induced skin disorder that begins as a reversible LR but can become fixed reticulated hyperpigmentation of the same pattern
  • Viruses exanthems - such as erythema infectiosum
  • Mechanical obstruction of blood flow

What can be done

In most cases this condition will resolve without the need for intervention. But if the skin appearance does not resolve when skin is warmed, or other signs or symptoms appear (nodules, ulcers for example), if you suffer from peripheral vascular diseases or autoimmune disease is suspected, or you are on medication, a doctor should be consulted.

In most cases of primary Livedo reticularis, it is self-resolving, but there are some lifestyle changes which may help avoidance and resolution. These include avoiding tobacco, cold temperature and minimising stress.

Tobacco smoking

Tobacco smokingSmoking affects the body in so many ways – none of them good. Smokers will often use tobacco to alleviate perceived stress, but on the contrary, tobacco can actually increase anxiety levels. It does this due nicotine has stimulating the release of adrenaline - which causes the heart to pump blood faster. Adrenaline is the hormone that is necessary during emergency situations.
Click here for further reading

Smoking can increase the formation of plaque in blood vessels, causing narrowing and restriction to blood flow. Chemicals in in cigarette smoke can cause blood to thicken and clot formation in veins and arteries.
For help with giving up smoking Click Here

Supporting circulation

Blood is transported throughout the body via blood vessels delivering oxygen and nutrition, transporting hormones, protecting from external harmful substances and removing the waste products of cellular metabolism. The circulation is also important for proper temperature control.

  • Ginseng berry extract improves blood circulation
  • Gingko biloba offers an anti-platelet activity and increases blood flow through the release of nitric oxide and prostaglandins
  • Cayenne pepper supports blood flow through a compound called capsaicin which is able to relax the muscles lining blood vessels
  • Omega 3 fatty acids (fish oil) supports blood flow
  • Turmeric (curcumin) improves vascular function
  • Ginger acts as a vasodilator widening blood vessels and supporting blood flow
  • Garlic contains a compound called allicin which helps blood vessels relax promoting blood flow
  • Exercise promotes circulation

Supporting circulationEat foods high in antioxidants support blood vessels and circulation. These include: red grapes, berries, pomegranate, kiwi fruit and citrus fruits (high in bioflavonoids to strengthen blood vessels).

The bottom line – physiologic livedo reticularis will usually resolve on its own and with secondary livedo reticularis, it is important to identify and treat the underlying condition.

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References

Livedo reticularis: A review of the literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4594389/

https://www.mayoclinic.org/livedo-reticularis/expert-answers/faq-20057864

https://www.dermcoll.edu.au/atoz/livedo-reticularis/

Systemic lupus erythematosus https://www.racgp.org.au/afp/2013/october/systemic-lupus-erythmatosus

https://rarediseases.info.nih.gov/diseases/5824/antiphospholipid-syndrome

https://www.researchgate.net/publication/281450988_Amantadine-Induced_Livedo_Racemosa

Amantadine-induced livedo reticularis--Case report https://pubmed.ncbi.nlm.nih.gov/26560223/

https://rarediseases.info.nih.gov/diseases/7664/sneddon-syndrome

A dermatologic manifestation of COVID-19: Transient livedo reticularis https://pubmed.ncbi.nlm.nih.gov/32283229/

Ginseng berry extract increases nitric oxide level in vascular endothelial cells and improves cGMP expression and blood circulation in muscle cells https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6199483/

Ginseng Berry Extract Prevents Atherogenesis via Anti-Inflammatory Action by Upregulating Phase II Gene Expression https://pubmed.ncbi.nlm.nih.gov/23243449/

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/ginkgo-biloba

Curcumin supplementation improves vascular endothelial function in healthy middle-aged and older adults by increasing nitric oxide bioavailability and reducing oxidative stress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310664/

The emerging role of curcumin for improving vascular dysfunction: A review https://pubmed.ncbi.nlm.nih.gov/28662351/

Tobacco smoking: Health impact, prevalence, correlates and interventions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490618/

Polyunsaturated fatty acids and cardiovascular disease https://pubmed.ncbi.nlm.nih.gov/20041811/

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