At first glance, livedo reticularis may appear to be a harmless, lace-like bluish-purple pattern on the skin, often triggered by cold. In many cases, it is benign and fades with warmth. However, when the pattern persists, it can be an important warning sign of serious underlying disease and should never be dismissed as “poor circulation.”
Livedo reticularis occurs when blood flow through small skin vessels becomes uneven, causing deoxygenated blood to pool and create a net-like discoloration. The key distinction lies between primary (benign) and secondary (pathological) forms. Primary livedo is temperature-related, common in younger individuals, and resolves with warming. Secondary livedo, by contrast, remains regardless of temperature and signals a structural or systemic problem affecting blood vessels or clotting.
Persistent livedo reticularis may be associated with serious conditions such as vasculitis, autoimmune diseases like lupus, antiphospholipid syndrome, blood-clotting disorders, cholesterol embolization, or rare syndromes such as Sneddon’s syndrome. In these cases, the skin pattern reflects impaired or obstructed blood flow and may coincide with pain, ulcers, neurological symptoms, fatigue, or signs of systemic illness.
Diagnosis typically involves clinical examination, blood tests for inflammation, autoimmune markers, and clotting abnormalities, and sometimes imaging or biopsy. Treatment focuses on addressing the underlying cause and may include anticoagulants, immunosuppressive therapy, or medications to improve circulation, along with lifestyle modifications.
While livedo reticularis can be harmless when temporary, persistent, painful, or progressive discoloration—especially when accompanied by systemic or neurological symptoms—requires urgent medical evaluation. Recognizing this distinction early can be critical in preventing severe complications such as stroke or tissue damage.
