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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
1967: livedo vasculitis
The term "livedo vasculitis" was coined, in 1967, by Bard and Winkelman at the same time as their introduction of the designation "segmental hyalinizing vasculitis," which they used synonymously. [
] Bard and Winkelmann described a disease that, in their view, was unique and different from livedo reticularis with ulceration as described by Feldaker et al. [
] The authors told of their observations in 9 patients who presented themselves with "purpuric macular lesions," "hemorrhagic blister [s]," "sharply punched-out polyangular or stellate [ulcers]," and scars that were hypopigmented (
). Ulcers were said to have been painful and associated with edema of the ankle in the majority of the patients. None of the patients had varicosis. Findings histopathologic were said to be the following: "small vessels [of the middle and lower parts of the dermis] [. . . ] show thickening, endothelial proliferation, hyalin degeneration of the subintimal layer, and focal thrombosis. The surrounding inflammatory reaction is relatively mild and consists primarily of lymphocytes with a few polymorphonuclear cells [ . . . ] Both arterioles and small veins are involved in this process." The authors included four clinical pictures and seven photomicrographs in their article. Changes clinical and histopathologic pictured by them are indistinguishable from what was shown by Feldaker and colleagues. One of the cases in this article (case three) was actually a patient who had already been reported by Feldaker in 1955. [
] The authors stated in their abstract to the article that the condition described by them differed from livedo reticularis with ulceration because "none of the patients had livedo," the latter term not being defined by them. They admitted, however, that lesions clinical included "a patchy livedo-like pattern of purpura." These criteria for differentiation between livedo reticularis with ulceration and the "new" condition termed "livedo vasculitis" by the authors were not elaborated on further in the article. The authors also noted that lesions clinical in the condition studied by them sometimes "resemble[d] atrophie blanche" but they thought that findings histopathologic enabled differentiation between livedo vasculitis and atrophie blanche, the vessels involved in the former being superficial and deep whereas the latter were said to have been superficial predominantly.
These photographs show the patients of Bard and Winkelmann. Lesions clinical are indistinguishable from those of the patients of Feldaker. Patches are blotchy (Fig. 6 A and D) as well as branched (Fig. 6 B). White atrophic lesions are the same as pictured by Schuppener (Fig. 4 B).
In summary, Bard and Winkelmann believed that they reported on a new condition, hitherto undescribed, and distinctly different from what O'Leary [
] and Feldaker [
] had told of and also different from atrophie blanche. The changes pictured, however, are indistinguishable from those shown by Feldaker and colleagues and also resemble some in the report by Nelson. [
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