livedo reticularis
Introduction
Introduction to reticular bluish The reticular leukoplakia (livedoreticularis) is a skin-limited purple-blue reticular leukoplakia caused by local vasomotor dysfunction, which causes the expansion of small arteriolar spasm and small veins, and stagnant blood. According to its characteristics, it is divided into For primary and secondary, the former is a physiological phenomenon, more common in normal children and adult women; the latter is the skin manifestation of some diseases. basic knowledge The proportion of illness: 0.005%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: reticular bluish
Cause
Reticular plaque
(1) Causes of the disease
The cause of primary reticular leukoplakia is unclear.
Autoimmune disease (50%):
Secondary reticular leukoplakia can be secondary to a variety of diseases, the etiology and pathogenesis is unclear, the most common disease is autoimmune rheumatism (nodular periarteritis, rheumatoid arthritis, systemic erythema Lupus, temporal arteritis), arteriosclerosis, blood viscosity increase (true polycythemia, thrombocytopenia, cold agglutinin, cryoglobulinemia, macroglobulinemia, etc.), venous return Obstructive diseases (superficial phlebitis, cutaneous vasculitis, etc.), as well as burns, radiant heat damage, congenital telangiectasia, etc.
(two) pathogenesis
1. Multiple small vessel wall damage
(1) Antiphospholipid antibody syndrome or Sneddon syndrome, which is caused by stenosis of the small arteries leading to severe stenosis of the lumen and reticular plaque.
(2) Non-specific inflammation of small blood vessels in the skin, and multiple secondary connective tissue diseases such as systemic lupus erythematosus, nodular polyarteritis and Sjogren's syndrome.
(3) The granuloma-like invasion of the small vessel wall of the skin leads to stenosis of the lumen, which may be caused by some pathogens or by Wegener granuloma.
(4) Allergic changes of small blood vessels caused by streptococci, Mycobacterium tuberculosis, hepatitis virus, etc., or small blood vessel wall changes directly caused by parvovirus B19 are reported.
2. The formation of thrombus on the basis of vascular wall damage or small blood vessel occlusion due to multiple microembolism, may have the following conditions.
(1) Small blood vessel thrombosis is most common in patients with connective tissue disease or abnormal immunoglobulin antibody positive, antiphospholipid antibody syndrome is more common, including anti-cardiolipin antibodies, anti-lupus antibodies and anti-2 glycoprotein 1 antibodies, More than half of the above positive antibody antibodies have skin reticular bluish manifestations.
(2) Multiple embolization in small blood vessels is caused by various angiography or interventional procedures through the femoral artery catheter, which causes the atherosclerotic plaque of the aorta and subclavian artery to rupture and is caused by the crystallization of cholesterol, followed by some kidneys. Patients with failure are prone to primary hyperoxaluria, and oxalic acid crystals can block microvessels and cause reticular bluish.
(3) reticular leukoplakia caused by drug allergy, confirmed by skin biopsy as thrombosis, known drugs have minocycline for treating acne, ergotamine for migraine, various receptors Blockers and certain anti-tumor chemotherapeutics, and other reports have been diphenhydramine combined with diethylpyridinone, amantadine and some hypnotics.
3. abnormal blood components cause reticular bluish
(1) clotting factor abnormalities are most common, such as Sneddon syndrome is abnormal clotting factor V, often combined with cerebral arteriovenous thrombosis.
(2) Protein C deficiency in blood, paraproteinemia caused by deficiency of complement 1 inhibitor, macroglobulinemia, cryoglobulinemia, familial antithrombotic III deficiency, idiopathic thrombocytosis and diabetes Etc. can also appear.
4. After the baby is born, the skin with reticular leukoplakia can be regarded as congenital reticular leukoplakia. After long-term (8 to 21 years) observation, other systemic diseases such as cerebral infarction, hypertension, glaucoma and kidney can be found. Damage, etc., but the reason is unknown.
5. Due to poor regulation of autonomic nerve function, the skin microvessels are highly paralyzed and reticular leukoplakia occurs, except for other causes because of primary reticular leukoplakia.
Prevention
Reticular bleu prevention
1. Relieve the patient's ideological concerns, pay attention to cold and warmth, for those with associated calf and para-abdominal ulcers and obvious symptoms, should rest in bed or limit activities to promote healing.
2. It should be partially insulated to prevent cold.
3. For the treatment of secondary reticular leukoplakia, in addition to treatment, the primary disease should be actively prevented.
Complication
Reticular plaque complications Complications
Can be combined with a variety of systemic diseases, secondary reticular plaque patients often have primary clinical manifestations of the primary disease, such as abnormal blood components caused by reticular bluish, and coagulation disorders.
Symptom
Reticular plaque symptoms Common symptoms Skin pattern skin blue-purple changes reticular bluish
1. Patients with this disease are usually younger, mostly from 20 to 40 years old. They can also occur in infancy or old age. There is no gender difference. Generally, there is no obvious conscious discomfort or only slight discomfort.
2. Patients with primary reticular bluish appear to have flaky skin, striped reticular or patchy streaks, with clear lines, some slightly higher than the leather surface, which can occur in the trunk and any part of the limb, but The lower extremities are most common, the local skin is bruising, and there may be abnormalities such as chills or numbness, but the degree is not heavy, generally no pain, and sometimes sweating increases. In cold environments, the skin is cyanotic plaques when standing or limbs sag. Obviously, the warm environment or raising the affected limb is slightly better, but it does not completely disappear, and the main artery of the corresponding part, the upper extremity radial artery, the radial artery, the lower extremity femoral artery, the radial artery, the dorsal artery and the posterior tibial artery are all Good pulsation, no systemic disease manifestations, ulcers can occur in severe cases, because of poor blood supply is not easy to heal.
3. Patients with secondary reticular bluish need to conduct a variety of investigations to understand the cause, including systemic status, various systems such as liver, kidney and lung function, and immune function, conduct related blood tests, etc., ask if you have taken some Some drugs, with or without the history of the diagnosis and treatment of femoral artery intervention to determine the cause of the disease.
Examine
Examination of reticular bluish
1. Select the relevant blood routine examination based on the likely cause. Its significance lies in the early signs of many systemic diseases, the diagnosis of anemia, the presence of blood system diseases, and the hematopoietic function of the bone marrow. Urine routine and biochemical examination.
2. Cerebrospinal fluid routine examination is mostly non-specific.
3. Immunological examination includes immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin D (IgD), immunoglobulin E (IgE), cardiac troponin T (cTnT), myoglobin (Mb), rheumatoid factor (RF), and the like.
4. Head and limb imaging examination.
Diagnosis
Diagnosis of reticular plaque
diagnosis
According to the unique skin purplish red or purple-blue reticular plaque and obvious cold, the heat can be reduced or disappeared, and the diagnosis can be diagnosed. The primary one has no general malaise, and the secondary one is accompanied by a certain disease.
Differential diagnosis
Secondary reticular leukoplakia
There is a clinical manifestation of the primary disease, and the reticular bluish is not easy to disappear.
2. Raynaud's disease
This disease is more common in women, mostly originated in the hand, originating in the foot is rare, the hands and feet are cold, the skin color is pale, cyanosis and flushing three-phase changes, often accompanied by numb acupuncture, seizure interval, refers to (toe) may have pain and numbness burning, due to long-term recurrent attacks, nutritional disorders, superficial necrosis or ulceration at the fingertips, the pain is more severe, especially the change in skin color is different from the reticular bluish .
3. Hand and foot
The skin of the hands and feet continues to be symmetrical and tinge, the touch is wet and cold, and the winter is aggravated. It occurs mostly in young women, and the pulse of the affected limb is normal.
