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Dermatopathology: Practical & Conceptual April - June 2006
6. Understanding livedo vasculitis: Part II—: Findings morphologic in “livedo vasculitis”
K. C. Nischal, M,D.
Almut Böer, M.D.
Findings clinical in selected quotations
Findings histopathologic in selected quotations
Summary of ancillary laboratory investigations
Answers based on clinicopathologic correlation
The site of lesions in LV is consistently mentioned to be the leg, usually both legs being involved almost symmetrically. The ankles and the dorsal aspects of the feet commonly are said to have been involved. Rarely, lesions have been encountered on the trunk or the upper extremities. Involvement of the distal acra is usually not mentioned specifically.
Descriptions of early lesions of LV vary considerably in articles reviewed by us. Small purpuric macules, papules, plaques, hemorrhagic vesicles and bullae, as well as hemorrhagic crusts, have been noted quite commonly, and lesions were always said to be painful. Few authors claimed that their patients also had had nodular lesions, which they assumed to be located in the subcutaneous tissue. Contradiction exists in articles about LV regarding the presence or absence of livedo reticularis or livedo racemosa. Whereas several authors stated specifically that no such lesions had been present in their patients, others describe what they call a localized and incomplete form of livedo, bluish retiform mottling, patchy livedo reticularis, livedo racemosa, or hyperpigmentation in a reticulate pattern.
There is unanimity among authors about the features clinical of late lesions in LV, i.e., superficial ulcers and scars. Ulcers are described almost always as polycyclic or bizarre-shaped and exceedingly painful. Several authors mentioned specifically that necrosis accompanied the ulcers and a few hypothesized that infarction might be the reason for ulceration and necrosis. Agreement exists also among the vast majority of authors about the presence of atrophic scars in LV. Whereas several authors described scars as hypopigmented, others took note of hyperpigmentation of scars. Authors stated that scars had assumed shapes stellate or branching. Telangiectases were said to surround scars in several of the reports quoted by us. Edema of the legs was said to have been an accompanying feature in several patients.
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