Livedo of the Forearm in the Aftermath of Forearm Erysipelas

Jochanan E Naschitz

doi:10.31579/2690-1919/216

Abstract

Livedo is an ischemic dermopathy caused by vasculopathies or prothrombotic states, and characterized by the violaceous lace-like mottling of the skin. We report on a patient who developed livedo reticularis – livedo racemosa overlap syndrome as a late sequel of erysipelas, the livedo being restricted to the limb segment affected earlier by erysipelas and devoid of systemic vasculopathy. Though erysipelas and livedo are common disorders, we could not find in the literature reports of an occurrence like that observed in this patient. In this case a favorable prognosis of livedo could be predicted. In a different context, livedo may be the alarming signal of an undiagnosed systemic disease.

Highlights

Livedo reticularis (LR) is an ischemic dermopathy characterized by the violaceous lace-like mottling of the skin forming complete dark rings surrounding a pale center that is caused by arteriolar vasospasm or flow disturbance as seen in polycythemia
We report on the occurrence of LR-Livedo racemose (LRa) in the aftermath of erysipelas, the livedo being confined to the segment previously affected by erysipelas and livedo persisting after recovery from erysipelas
Livedo persisted long after recovery from erysipelas. By all these features livedo in this patient differs from livedo which complicates Covid-19 disease. Livedo in this patient occurred as a late sequel of erysipelas and was restricted exclusively to the limb segment affected by erysipelas

Summary

Introduction

Livedo reticularis (LR) is an ischemic dermopathy characterized by the violaceous lace-like mottling of the skin forming complete dark rings surrounding a pale center that is caused by arteriolar vasospasm or flow disturbance as seen in polycythemia. Livedoid vasculopathy is characterized by punched out ulcers in the peri-malleolar area surrounded by lacy, reticular, streaks of LR These ulcers heal forming white scars surrounded by telangiectasias and are remnants of infarction due to disturbed capillary microcirculation. We report on the occurrence of LR-LRa in the aftermath of erysipelas, the livedo being confined to the segment previously affected by erysipelas and livedo persisting after recovery from erysipelas Though both erysipelas and LR are frequent disorders, we could not find in the literature reports of a similar sequence of events. The 28th of July an extensive erythema appeared on her left forearm: tense, red, hot, uniformly elevated, with a sharply defined, raised border. There was no alteration in the patient’s general state, temperature, blood pressure, heart rate and SpO2

Discussion

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Conclusion