If you look carefully you can see something really interesting going on here. There you go. Is your nose touching your phone? Do you see it?

This is called livedo reticularis.

The blood flow in the smaller veins called venules that service the skin here has become obstructed to some degree. As a result, these venules swell up and give this mottled-reticular looking pattern that is apparent here, hence the name.

It tends to rear its head more during exposure to cold, because of the vasoconstriction cold causes.

Usually, it impacts the extremities… hands, arms, feet and legs and is regarded benign in some cases. The issue with livedo reticularis is that it is an incredibly unspecific sign, meaning there are dozens of different disease states that produce this skin finding.

Livedo reticularis has been associated with a very long list of factors including:

Iron deficiency

Vitamin B3 deficiency

Certain medications (for neurological disorders)

Sex hormone imbalance

Hypothyroidism

Lupus

Rheumatoid Arthritis

Dermatomyositis

Mixed Connective Tissue diseases and Ehlor Danlos syndrome

Antiphospholipid Syndrome

Vasculitis autoimmune conditions

Some experts consider it a benign response to cold weather. And so how do we figure out whether it’s simply that or secondary to something deeper going on.

In my world, it tends to make us suspicious of something more complex going on, especially when occurring with a certain constellation of symptoms, physical exam findings and blood metrics.

It’s more concerning when it isn’t responsive to rewarming and is persistent over longer periods of time. Or if you’ve been diagnosed with a systemic disease and it’s suddenly appeared.

Do you have livedo reticularis?

Is it connected to a disease you’ve been diagnosed with?

Further Reading

Livedo Reticularis: A Review of the Literature