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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
1992: livedo vasculopathy
In 1992, McCalmont and colleagues suggested the term "livedo vasculopathy" as a synonym for livedo vasculitis. In their opinion, the designations livedo vasculitis, segmental hyalinizing vasculitis, and atrophie blanche were designating one and the same disease (
] The authors had observed that fibrinopeptide A levels were elevated markedly in the serum of six patients with livedo vasculitis and they found that features that they deemed requisite for making the diagnosis of small vessel vasculitis, namely, leukocytoclasis, infiltrates of neutrophils in vessel walls, and immunoreactants within vessel walls, were absent in lesions of livedo vasculitis. They concluded that a "thrombogenic state" might be involved in the pathogenesis of the disease and, therefore, considered the term livedo vasculopathy more appropriate than livedo vasculitis. A similar suggestion had already been made a decade earlier, by Shornick et al. Those colleagues had studied atrophie blanche, which they used synonymously with segmental hyalinizing vasculitis, and with livedo reticularis with summer ulceration. In 12 patients they noted absence of typical features of leukocytoclastic vasculitis such as infiltrates of leukocytes and leukocytoclasis and suggested that the condition should be termed a vasculopathy in order to differentiate it clearly from leukocytoclastic vasculitis.
When McCalmont and colleagues, in 1992, suggested the term livedo vasculopathy instead of livedo vasculitis, they included pictures of lesions clinical in one of their patients. Lesions are indistinguishable from those shown by Feldaker (Figs. 2 and 3), Winkelmann (Figs. 6 and 7), Schuppener (Fig. 4), and Milestone (Fig. 8).
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