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Dermatopathology: Practical & Conceptual July - September 2005
4. Understanding livedo vasculitis: Part I—A glossary, in historical perspective, of terms related to "livedo" and "livedo vasculitis"
K. C. Nischal, M.D.
Almut Böer, M.D.
1860: livedo reticularis
1907: livedo racemosa
1929: atrophie blanche
capillarite télangiectasique et atrophiante
capillarites sclérosantes et atrophiantes
1953: capillaritis alba
1955: livedo reticularis with summer ulceration
1956: livedo reticularis with ulcerations
1957: atrophia alba
1965: Sneddon syndrome
1966: periodic painful ulcers of lower extremities
1967: livedo vasculitis
1967: segmental hyalinizing vasculitis
1974: livedoid vasculitis
1974: livedo reticulosis
1974: vasculitis of atrophie blanche
1983: PURPLE (painful purpuric ulcers with reticular patterning on the lower extremities)
1992: livedo vasculopathy
1998: livedoid vasculopathy
Suggestion for terminology
I. Useful terms
II. Confusing terms—to be avoided
III. Antiquated terms—not to be used any more
1907: livedo racemosa
The term "livedo racemosa" was coined by Ehrmann in 1907 [
] to describe lightning-shaped macular lesions with a bluish red color fading at the periphery of the lesions and merging into the adjacent skin. Livedo racemosa, translated from the Latin, designates a pale bluish macule of the skin that assumes a ramified shape that resembles the branches of a tree. Ehrmann emphasized that macules of livedo racemosa were not responsive to warming the skin because they are not the consequence of vasospasms as it is the case in livedo reticularis
livedo reticularis.) Livedo racemosa is always a sign of a pathologic process involving small vessels of the dermis. The same pattern can be produced by deposits of fibrin in vessel walls, by thrombi in the lumen of vessels, by calciphylaxis, by cholesterol emboli, and by an intravascular lymphoma. It is not surprising, therefore, that a variety of disorders of coagulation may produce the pattern of livedo racemosa in the skin.
In the literature of dermatology written in English, the terminology has become confusing in the past decades, especially since Champion used the term livedo reticularis as a generic one for all kinds of livid macules with branched as well as netlike shapes (Figs.
] Livedo reticularis has commonly come to be used interchangeably with livedo racemosa in the literature of dermatology written in English. A variety of subclassifications of livedo reticularis (e.g., "transient" and "persistent" or "systemic" and "idiopathic" or "blanchable" and "necrosing") have been suggested for clarification, but actually have produced even more confusion.
These pictures come from the article by Champion, in 1965 on what he called livedo reticularis. Note that in all pictures, the pattern of lesions is branched and ramified rather than reticular. Correctly, these lesions should be designated livedo racemosa.
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