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50-Year-Old Female with Discoloration on Arms

Can you diagnose this case?

David L. Kaplan, MD

Signs and Symptoms

This 50-year-old woman presented for evaluation of asymptomatic but persistent discoloration on her arms of 2 months’ duration. She has seen her primary care physician, who ordered a complete blood cell count, a comprehensive metabolic panel, and an antinuclear antibody test, the results of which were all normal. Her rheumatoid factor was found to be elevated, but she denied any joint pain. The only other relevant finding on physical examination was an asymptomatic area of discoloration on her chin that had appeared without any history of trauma.

What is the cause of the rash on this woman’s arms?

Choose one to reveal diagnosis and discussion

Eczema
Psoriasis
Dermatomyositis
Livedo reticularis
Erythema ab igne

Answer: Livedo reticularis

See the full case at Consultant360

Livedo reticularis refers to a mottled appearance to the skin that has a net-like or mesh-like appearance. The condition results from a disturbance of blood flow to the skin, causing decreased blood flow and subsequent reduced oxygen tension to the skin. Livedo reticularis has many associated conditions, including hypercoagulopathies, autoimmune diseases, infections, and drug reactions, to name a few. This patient had an underlying connective tissue disease, with cutaneous lupus erythematosus on her chin and a positive rheumatoid factor. She was educated on avoiding exacerbating conditions such as cold weather; she also was offered oral antimalarial therapy, which she declined given that the rash was asymptomatic. She will have regular follow-up to monitor for possible systemic progression of disease.

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