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Leg, foot and nail disease in the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
M. Alam, R. K. Scher, P. I. Schneiderman
Hypertensive ulcers47–19, more often noted in women, are superficial ulcerations that occur in the presence of peripheral pulses. Livedo may be observed at the site of the ulcers, which have a reddish-yellow edge and are exquisitely painful. Most hypertensive ulcers arise on the anterior aspect of the lower two-thirds of the leg. Trauma may be a causative factor.
Anti-Phospholipid Antibodies: Clinical Complications Reported in Medical Literature
Published in E. Nigel Harris, Thomas Exner, Graham R. V. Hughes, Ronald A. Asherson, Phospholipid-Binding Antibodies, 2020
Livedo reticularis, a cyanotic, geographically distributed “network” pattern of dilated superficial veins, often precipitated or aggravated by cold, may occur in normal children and adults (usually female). It is referred to as “cutis marmorata” and is caused by capillary stasis in areas of skin farthest from the cutaneous arteriolar blood supply. It occurs particularly on the lower limbs and has been described in many situations where stasis of blood in the superficial venous plexus of the skin might occur, such as in vasculitic conditions (e.g., polyarteritis nodosa) atheromatous vascular disease, or with certain blood disorders such as idiopathic thrombocythemia, TTP or polycythemia vera. It also occurs in the condition referred to as livedo vasculitis.23 It may also be seen with connective tissue disorders. It was first documented as occurring in SLE by Golden in 196324 and in 1984, Hughes first commented on the increased frequency of the condition in patients with SLE and aPL antibodies.25 Other authors have now confirmed this association.
Neurofeedback in an Integrative Medical Practice
Published in Hanno W. Kirk, Restoring the Brain, 2020
The physical exam was significant for increased heart rate of 93, with an otherwise normal cardiac examination. Her abdomen demonstrated generalized tenderness with no other findings. Skin showed livedo reticularis.
Monoclonal antibodies for treatment of cold agglutinin disease
Published in Expert Opinion on Biological Therapy, 2023
Georg Gelbenegger, Sigbjørn Berentsen, Bernd Jilma
In CAD, monoclonal autoantibodies (cold agglutinins), typically of the IgM kappa class, bind to cell surface antigens on red blood cells (RBCs) at a specific temperature range (below or up to 37°C). The thermal amplitude reflects the highest temperature at which the cold agglutinin binds to its antigen [14], and cold agglutinin activity (titer) is expressed as the inverse value of the highest serum dilution at which RBC agglutination can be detected [15]. Most cold agglutinins have a specificity for the I antigen on RBCs [16], and multiple regions within immunoglobulin heavy chains and immunoglobulin light chains contribute to I antigen binding, which may influence the clinical phenotype [17,18]. The pentameric structure and large molecular size of IgM autoantibodies allow for agglutination of RBCs [19,20], leading to peripheral (mostly acral) blood vessel occlusion and circulatory symptoms, such as acrocyanosis, Raynaud-like phenomena, and, rarely, gangrene [10,13]. Atypical dermatologic features include livedo reticularis and livedo racemosa [21–23]. Patients with CAD may also have a higher risk of thromboembolism and early death [24]. Notably, mortality in CAD shows a seasonal pattern [25]. At least one thromboembolic event occurs in almost a third of CAD patients [26]. Circulatory symptoms are usually reversible as RBC agglutinates disaggregate when re-exposed to higher temperatures. Notably, the degree of acrocyanosis does not correlate with the severity of anemia [12].
Efficacy of an anti-TNF-alpha agent in refractory livedoid vasculopathy: a retrospective analysis
Published in Journal of Dermatological Treatment, 2022
Livedoid vasculopathy, also called livedo vasculitis and segmental hyalinizing vasculitis, is a type of chronic skin disorder. Livedoid vasculopathy is characterized by recurrent purpura or necrotic macules and painful ulcers on the lower extremities with summer exacerbations. These shallow ulcers may heal into atrophic porcelain satellite scars, termed atrophie blanche, and are often accompanied by peripheral telangiectasia and hyperpigmentation. The etiology and pathogenesis of livedoid vasculopathy still remain unknown. Livedoid vasculopathy is characterized histologically by intraluminal thrombosis, endothelial proliferation, and segmental hyalinization in dermal vessels. Therefore, livedoid vasculopathy is generally considered to be a thrombo-occlusive vasculopathy of cutaneous blood vessels, with occlusion of the cutaneous capillary microcirculation, leading to thrombosis, ischemia, and infarction (1).
Contribution of HLA-DRB1 * 09: 01 allele to development of minocycline induced antineutrophil cytoplasmic antibody (ANCA)-associated cutaneous vasculitis: report of two cases
Published in Modern Rheumatology Case Reports, 2020
Hiroyuki Kawahara, Akikatsu Nakashima, Takeshi Zoshima, Mitsuhiro Kawano
A 53-year-old woman receiving minocycline for 24 months presented with fever, numbness and livedo reticularis with tenderness on the bilateral lower legs. Two years earlier, oral administration of minocycline had been started in our department of dermatology. After that, no pustules developed, and the condition was stable. Livedo with tenderness on the bilateral lower legs appeared two months before the visit, a fever about 38 °C and numbness of the bilateral legs appeared about one month before the visit. The numbness was limited to the livedo, and no thermal hyperalgesia was present. Laboratory findings included CRP 2.2 mg/dL, AST 62 IU/L, ALT 78 IU/L and Cr 0.54 mg/dL. Urinalysis showed no obvious abnormal findings. MPO-ANCA was 64.7 EU/mL and ANA was 160 times (Homogenous/Nucleolar pattern), but RF, anti-ds DNA antibody and PR3-ANCA were negative. DAV caused by minocycline was suspected. The patient initially rejected a skin biopsy. Minocycline was stopped, after which the clinical symptoms rapidly disappeared, and CRP became negative. MPO-ANCA decreased to 16.5 EU/mL 35 weeks after drug discontinuation. The patient after additional explanation from her physicians then decided to permit a skin biopsy which was performed from above a femur 19 days after drug discontinuation and which showed a slight chronic inflammatory cell infiltrate mainly composed of lymphocytes in the perivascular area of the dermal surface layer. Further examination revealed HLA-DRB1(08:02:01, 09:01:02) allele.