# Livedo Reticularis and Livedoid Vasculopathy > Livedo reticularis and livedoid vasculopathy for NEET-PG Dermatology, with pathological livedo, antiphospholipid links, painful ulcers and atrophie blanche. - Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/livedo-reticularis-and-livedoid-vasculopathy - Exam / course: NEET-PG · Subject: Dermatology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Rook's Textbook of Dermatology; IADVL Textbook of Dermatology - How to cite: "Livedo Reticularis and Livedoid Vasculopathy", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/livedo-reticularis-and-livedoid-vasculopathy ## Direct answer Livedo reticularis is a reticulate, violaceous mottling of the skin caused by a dilated dermal vascular network, and it is physiological when cold-induced and reversible but pathological when persistent, as in livedo racemosa. Livedoid vasculopathy is a chronic thrombotic disorder of dermal vessels that causes painful, recurrent ulcers on the lower legs, which heal with atrophie blanche. Antiphospholipid antibodies are frequently associated with pathological livedo, so testing is essential. ## What you must remember - **Physiological livedo:** cold-induced, reversible on warming and clinically insignificant, needing no work-up. - **Livedo racemosa:** persistent, with a broken, branching net-like pattern that signals a possible systemic cause. - **Associations:** antiphospholipid syndrome, SLE, cryoglobulinaemia and polyarteritis nodosa. - **Sneddon syndrome:** livedo reticularis with cerebrovascular events, often with antiphospholipid antibodies. - **Livedoid vasculopathy:** painful, recurrent ulcers on the ankles and lower legs, with thrombosis of dermal vessels. - **Atrophie blanche:** ivory-white, atrophic, stellate scars with telangiectasia that mark healed livedoid ulcers. - **Histology:** often shows intraluminal hyaline thrombi and fibrin in dermal vessels, with little vessel wall inflammation. - **Treatment:** antiplatelet agents form the core, with pentoxifylline and anticoagulation used in selected patients. ## A work-up from net-like rash to thrombophilia A woman with a net-like purple rash on the legs and recurrent painful ankle ulcers raises the question of a systemic cause. The steps below sort physiological from pathological disease and then test for thrombophilia. 1. **Classify the livedo.** Physiological livedo fades on warming, whereas livedo racemosa persists with a broken, branching pattern. 2. **Screen for a systemic cause.** Ask about strokes, miscarriage, thrombosis and joint symptoms, and look for features of SLE, vasculitis or cryoglobulinaemia. 3. **Send targeted tests.** Anticardiolipin and anti-beta2 glycoprotein I antibodies, lupus anticoagulant, ANA and cryoglobulins, chosen according to the clinical picture. 4. **Biopsy an ulcer edge.** Histology from the margin of a painful ulcer showing dermal vessel thrombosis points to livedoid vasculopathy. 5. **Treat the vessels and the pain.** Start antiplatelet therapy, consider pentoxifylline and use anticoagulation in selected patients, with analgesia and wound care alongside. 6. **Follow up for thrombosis.** Monitor antiphospholipid-positive patients for stroke, venous thrombosis and pregnancy complications. ## Where candidates lose marks Points of confusion on this topic usually come from mixing up harmless livedo with a warning sign. - **Trap:** calling all livedo a sign of antiphospholipid syndrome — **Correct:** physiological livedo is cold-induced and reversible and needs no work-up, while persistent or racemose livedo warrants antibody testing. - **Trap:** treating livedoid ulcers as venous ulcers only — **Correct:** livedoid vasculopathy is a thrombotic vasculopathy, so compression alone is inadequate and antithrombotic therapy is central. - **Trap:** dismissing atrophie blanche as an incidental scar — **Correct:** it is a characteristic marker of healed livedoid ulceration and points to the underlying vasculopathy. ## Frequently asked questions ### What distinguishes physiological from pathological livedo reticularis? Physiological livedo reticularis is cold-induced, reversible on warming and clinically insignificant. Pathological livedo, such as livedo racemosa, is persistent, has a broken branching pattern and may signal antiphospholipid syndrome or vasculitis. ### Which antibodies are associated with livedo racemosa? Antiphospholipid antibodies, including anticardiolipin and anti-beta2 glycoprotein I antibodies, along with lupus anticoagulant, are associated with livedo racemosa. Testing is recommended because these antibodies carry thrombotic and obstetric risk. ### What is atrophie blanche in livedoid vasculopathy? Atrophie blanche is an ivory-white, atrophic scar with telangiectasia that remains after healed livedoid ulcers. Its presence alongside painful ankle ulcers is characteristic of livedoid vasculopathy. ### What is Sneddon syndrome? Sneddon syndrome is livedo reticularis associated with cerebrovascular events such as stroke, often with antiphospholipid antibodies. Recognising it matters because the neurological risk is serious and needs antithrombotic management. ### How is livedoid vasculopathy treated? Livedoid vasculopathy is treated mainly with antithrombotic therapy, with antiplatelet agents at the core and pentoxifylline and anticoagulation used in selected patients. Pain control and wound care support healing, and the underlying cause should be assessed.