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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
1974: livedoid vasculitis
In 1974, Winkelmann along with colleagues wrote again about the condition he called segmental hyalinizing vasculitis. [
] Even though Bard and Winkelmann had, in 1967, used that designation synonymously with the term livedo vasculitis, they now used it interchangeably with livedoid vasculitis. The authors, however, did not comment about why they made this change in nomenclature and they also did not define what they meant to say with "livedoid." Livedoid means "resembling livedo," but that is not a meaningful definition because livedo means pale blue in color and it is not clear how that state should be resembled; skin is either pale blue or it is not. When authors use the term "livedoid" they usually mean either "resembling livedo reticularis" or "resembling livedo racemosa," or "resembling livedo vasculitis" but Winkelmann et al. did not clarify in their article, to what precisely they were referring.
Whereas in 1967, Bard and Winkelmann had stated specifically that the condition described by them as segmental hyalinizing vasculitis was different from livedo reticularis with ulcerations, the study published in 1974 included 37 patients, nine of whom Winkelmann et al. had reported on in their article of 1967 (then diagnosed with livedo vasculitis, not with livedoid vasculitis), but also "some selected former cases of 'livedo reticularis with summer or winter ulceration' which were reevaluated as being cases of livedoid vasculitis." The findings clinical demonstrated in four photographs are indistinguishable from what was pictured by Feldaker (
] A photomicrograph was not included by the authors in their article. Findings histopathologic were given short shrift. The authors concluded that "livedoid vasculitis is a reaction pattern of the skin, sui generis," a statement that was not explained further by them. Whereas in 1967, Bard and Winkelmann had mentioned atrophie blanche as a differential diagnosis of livedo vasculitis, Winkelmann et al., in 1974, stated that "atrophie blanche [is ] identical with the end stage or healing stage of livedoid vasculitis."
The condition designated by Winkelmann and coworkers livedoid vasculitis was illustrated with these pictures. Lesions are indistinguishable from those shown by Feldaker et al. (Figs. 2 and 3) as well as by Bard and Winkelmann (Fig. 6) before. Note also the similarity to the lesions pictured by Schuppener (Fig. 4).
In conclusion, Winkelmann and collaborators, in 1974, referred to the same condition with three different terms, namely, segmental hyalinizing vasculitis, livedo vasculitis, and livedoid vasculitis, and they also had noted that some of the patients diagnosed previously as livedo reticularis with ulcerations or as atrophie blanche probably had the same condition. The authors did nothing to clarify terminology but rather made it more complicated by introducing the term livedoid without defining it.
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