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Dermatopathology: Practical & Conceptual October - December 2006
9. Understanding "livedo vasculitis": Part III—Considerations about etiology and pathogenesis
K. C. Nischal, M.D.
Almut Böer, M.D.
Conditions associated with livedo vasculitis
In part I of our series titled "Understanding 'livedo vasculitis' ," we addressed all terms associated with "livedo" and with "livedo vasculitis" in historical perspective. [
] In the second part of our series, we elaborated, in detail, findings clinical and histopathologic in patients diagnosed with LV (or with one of the designations used synonymously with it). [
By way of comparison of what is written and pictured in articles from the past, we concluded that Milian (1929), [
] Gougerot et al. (1936), [
] O'Leary (1944, 1955), [
] Ellerbroek (1953), [
] Nelson (1955), [
] Feldaker et al. (1955, 1956), [
] Schuppener (1957), [
] Gray et al. (1966), [
] Bard et al. (1967), [
] Winkelmann et al. (1974), [
] Gilliam et al. (1974), [
] Milstone et al. (1983), [
] McCalmont et al. (1992), [
] and Papi et al. (1998), [
] told of the very same disease entity, even though they gave 14 different names to it. For purposes practical, we suggested to refer to this condition as "livedo vasculitis" (LV).
Histopathologic features of LV as they can be found in articles on the subject are the presence of fibrin in the walls of vessels and/or thrombi in the lumina together with a perivascular dermatitis, in capillaries of the papillary dermis, venules on all levels of the reticular dermis, and sometimes also including those situated in the upper part of the subcutaneous fat. [
] Lesions clinical vary according to the depth in the dermis of the vessels affected. Results of direct immunofluorescence as well as findings histopathologic indicate that a variety of different circumstances can produce the same morphologic changes. [
] We concluded that LV is not a specific disease, but that it is a distinctive pattern of changes that may occur in a variety of different circumstances.
In this, the last part of this series of articles we analyze all diseases that have been said to be associated with LV and we try to identify features in common among them in order to learn more about etiology and pathogenesis of the condition.
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