Who Gets Livedo Reticularis
Cutis marmorata causes temporary or physiological livedo in about 50% of healthy infants and many adults, particularly young women when exposed to the cold.
Cutis marmorata telangiectatica congenita is a rare condition in which pronounced livedo is present at birth or soon after. It often improves with age. There are several congenital abnormalities associated with cutis marmorata telangiectatica.
Primary livedo reticularis is the idiopathic form in adults and can be persistent. The diagnosis is usually made once other more severe causes of livedo reticularis have been ruled out.
Secondary livedo, or livedo racemosa, is associated with a range of systemic diseases.
Does The Mottling Of Skin Occur Before Death
Yes. Since the person is nearing death, circulation only comes to the vital organs. What is mottling for those nearing death? Mottling often comes around one to four weeks before the end of life. However, it is not always the case and will vary per individual. The mottling comes from the skin temperatures going from highs to lows repeatedly, making the skin pale and moist. It starts near the bottom parts of the body, such as the feet.
What Does Skin Lymphoma Look Like
Different types of skin lymphoma can look quite different from one another, particularly in the early stages.
This section includes photographs to illustrate the appearance of skin lymphomas. However, do not be alarmed if your skin has a similar appearance. There are many more likely and less serious skin conditions that may look similar, but can only be distinguished from skin lymphoma using specialised tests on the cells of the affected skin.
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What Is Cutaneous Lupus Erythematosus
Systemic lupus is a type of autoimmune disease where your immune system attacks your body, including your internal organs. In cutaneous lupus, your immune system attacks your skin. About 10% of all lupus cases are cutaneous and 65% of people with systemic lupus will develop skin lupus.
Women are much more likely to have lupus. Around 90% of people with lupus are women between ages 15 to 44. However, people of all genders and ages can get it. Lupus in children usually develops around age 12. Your risk of developing lupus is higher if you have a relative with lupus or another autoimmune disorder.
Women of color are about two to three times more likely to have lupus. Its much more common among women who are Black, Hispanic or of Asian descent.
Who Diagnoses Skin Lymphoma
Diagnosing skin lymphoma is a bit like solving a jigsaw puzzle. A team of people from different hospital departments are involved in identifying the pieces and putting them together. This might include a dermatologist , haematologist , or clinical oncologist who specialises in lymphoma and other healthcare professionals, who work as part of a multidisciplinary team . You might only meet a few of these people but they are all involved in diagnosing your condition and recommending the best treatment for you.
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Catching Lupus Early On
Head of arthritis and immunology research at the Oklahoma Medical Research Foundation Dr. John Harley, conducted research that suggests that lupus infects the body in three stages.
During the second stage, autoantibodies within the blood cells are present but it isnt until the third stage that these autoantibodies become severe enough to cause outwardly physical symptoms.
Harleys findings suggest that early blood work could lead to faster diagnoses of lupus in patients.
Nail Changes Due To Lupus
There are two kinds of changes that can happen around the nails in lupus. The first kind is peritubular capillary changes, which are vascular changes in the little blood vessels around the nails,” notes Stojan. These tiny vessels can be dilated or broken near the surface of the skin and appear as fine pink or red lines.
This condition can occur with certain autoimmune diseases, including lupus, says Stojan. We can sometimes distinguish between different autoimmune diseases based on how those capillaries look under a microscope.
The other change that you can see is a rash or reddening of the skin around the nail, which is referred to as a periungual rash or periungual erythema, says Stojan.
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Skin And Mucous Membrane Findings
Malar rash is a fixed erythema that typically spares the nasolabial folds. It is a butterfly-shaped rash that can be flat or raised over the cheeks and bridge of the nose .
Discoid rash occurs in 20% of patients with SLE and can result in disfiguring scars. The discoid rash can present as erythematous patches with keratotic scaling over sun-exposed areas of the skin. Follicular plugging may create scarring that may be well demonstrated in the ears. Systemic manifestations of SLE may be absent .
Lupus should be considered in all patients who experience oral, or less frequently, vaginal ulcers ulcers classically occur more than 3 times per year and are painless. Palatal ulcers are most specific for SLE.
Many other cutaneous findings are not explicitly diagnostic features but support impressions of SLE. Alopecia in SLE often causes hair loss at the temporal regions or creates a patchy pattern. Vascular lesions such as livedo reticularis , periungual erythema , telangiectasias, and Raynaud phenomenon may develop in some patients with SLE or antiphospholipid antibody syndrome. However, these are nonspecific findings, as they can occur in other connective tissue disorders with prominent vascular involvement, such as scleroderma and dermatomyositis. Panniculitis, bullous lesions, vasculitic purpura, and urticaria are other skin lesions that are sometimes seen in SLE.
What Are The Symptoms Of Lupus
Lupus can affect many parts of the body, including your joints, skin, and organs. It depends on the kind of lupus you have. Symptoms can develop quickly or slowly. They also can come and go and be mild or severe.
Not everyone who has lupus has the same symptoms. Common symptoms of lupus may include:
- Sensitivity to the sun or light.
- Joint pain or swelling.
- Chest pain with deep breathing.
- Trouble thinking, and/or memory problems.
- Kidney problems.
Many people also have symptoms that affect their skin and hair, such as:
- Red rashes, often on the face and in the shape of a butterfly
Lupus may also cause symptoms that affect the blood and blood vessels:
- Low blood count.
- Pale or blue fingers or toes from cold or stress .
Less common symptoms include:
- Weight loss or weight gain.
- Hallucinations.
- Repeated miscarriages or other infertility problems.
Children can have the same symptoms of lupus as adults. The most common symptoms in children are:
- A red, butterfly-shaped rash over the bridge of the nose and the cheeks.
- Low red blood cell count .
- Low white blood cell count .
- Severe brain or kidney problems.
It is common for lupus symptoms to come and go. Often, they may disappear for a period of time called remission. You may get new symptoms all of a sudden. When symptoms appear or get worse, its called a flare. You may have swollen joints and muscle pain one week and then no symptoms at all the next week.
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Who Does Lupus Affect
Most people with lupus receive a diagnosis between the ages of 15 and 44. Only around 15 percent of people experience symptoms of lupus before the age of 18.
Demographic and other factors can affect the severity and progression of the condition. Lupus is most prevalent among women of childbearing age, and it is two to three times more prevalent among women of color, according to the Lupus Foundation of America.
No single test can diagnose lupus. Instead, a doctor must look for signs of systemic inflammation, which indicates that the immune system may be attacking the body.
To help with diagnosis, doctors may:
- take a complete medical history, including a log of all symptoms and how they have changed over time
- take a family medical history
- conduct blood tests to rule out other conditions and to look for signs of systemic inflammation
- carry out an antinuclear antibody test, which is a blood test that looks for signs of autoimmune conditions but which cannot specifically diagnose lupus
In some cases, a doctor may recommend waiting to see how and whether symptoms change over time.
Lupus is a chronic condition. There is currently no cure, but there are some treatments that can help a person manage their symptoms and prevent serious complications.
The right treatment varies from person to person, and a persons treatment needs may change with time. Sometimes, a medication that once worked well stops working or begins to cause severe side effects.
Are There Different Types Of Cutaneous Lupus
There are three types of cutaneous lupus. Each type has similar symptoms, including a red, scaly rash that often results from exposure to the sun.
The three kinds of cutaneous lupus are:
In this type of cutaneous lupus, the skin lesions are round , thick, scaly and red. You may experience symptoms including pain, itching and burning. In some cases, you may not experience any symptoms. Most often, symptoms will develop on your face, ears or scalp. However, you can develop symptoms on other parts of your body too. This condition can sometimes cause scarring and discolorations on your skin . If you develop this condition on your scalp, it might lead to hair loss which may be permanent.
Discoid lesions that have been on your skin for years can potentially develop into skin cancer. These lesions should be monitored carefully and any changes should be reported to your healthcare provider. If you have discoid lupus, your provider will schedule regular checkups to monitor your health.
When you have subacute cutaneous lupus, red borders develop around the edges of these lesions. They can look like a ring with a darker red circle on the ring’s outer edge. The skin is red and scaly. These lesions can result from a reaction to certain medications.
This characteristic butterfly rash is a sign of systemic lupus. People who develop this type of rash could have lupus symptoms in other areas of their body as well.
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Undifferentiated Connective Tissue Disease
There are people who have a milder form of an autoimmune disease who just dont meet the classification criteria for lupus. We call that undifferentiated connective tissue disease , says Dr. Petri.
In other words, they have some features of an autoimmune disease but they dont have all the characteristics of lupus or RA, Dr. Blazer explains. They may test positive for antinuclear antibodies . They also have symptoms that can look like lupus, including hair loss, rashes, and achy or swollen, red joints. They may have anemia. But they dont typically go on to develop problems with their kidneys, liver, or other organs.
Some rheumatologists believe that these patients have early-stage lupus, and some believe that it is its own condition that never turns into lupus, says Dr. Blazer.
About 10 percent of people with UCTD will develop lupus. Patients diagnosed with UCTD should continue to see a rheumatologist, says Dr. Petri. That way, the doctor can keep tabs on your symptoms and continue to do lab tests to check to see if there is any organ damage.
Since UCTD usually produces mild symptoms, doctors usually recommend NSAIDs or pain relievers for joint pain and topical steroid creams. For rashes and other skin disorders, a doctor may prescribe hydroxychloroquine, an antimalarial medication that goes by the brand name Plaquenil.
Joint Pain And Swelling
Up to 90% of people with lupus will have arthritis, which is defined as inflammation or swelling of the joint lining. The most common symptoms of arthritis are stiffness and aching, most often in the hands and wrists. Symptoms of arthritis can come and go and move from one joint to another. Pain and stiffness tend to be worse in the morning and improve as the day goes on. People with lupus can also experience pain in the joints without swelling or tenderness, which is referred to as arthralgia.
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Mottled Skin In Children And Babies
Mottled skin can sometimes show up in newborns and babies. Often, this results from a cold environment and should disappear if you add another layer of clothing and keep them warm.
Rarely, thyroid problems can also cause mottled skin in newborn babies. If discoloration is due to thyroid problems, the baby may also have jaundice or face puffiness. Roughly 1 in 4,000 babies are born with hypothyroidism, a condition treatable with daily medication .
When To See A Doctor
Shock requires immediate medical attention. If you have symptoms of shock, get help right away.
If you have symptoms of lupus or a vascular condition along with mottled skin, see a healthcare provider. You may need to work with them long-term to manage your condition.
Also, its a good idea to speak with a healthcare professional if your mottled skin is new and has only appeared since starting a new medication. They can assess whether the skin change is a side effect of the prescription and work with you to prevent it.
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Symptoms That May Suprise You
In this video, Anna Scanlon with New Life Outlook surfaces some less talked about symptoms, including depression and anxiety.
Severe headaches and weakened teeth health may result, as well. Unfortunately, all of these symptoms are often overlooked as issues occurring independently of a major diagnosis, such as lupus.
How Do Healthcare Providers Diagnose Cutaneous Lupus
If you know you have lupus, your healthcare provider can diagnose cutaneous lupus by examining your skin and evaluating the rash. Your provider may take a sample of your skin and send it to a lab for testing.
If you notice a rash but havent received a lupus diagnosis, your provider will do a thorough exam. They will ask about other symptoms and your family history of autoimmune disease.
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How Do Healthcare Providers Treat Cutaneous Lupus
Healthcare providers help people manage cutaneous lupus with lifestyle changes and medications. Your provider may recommend:
- Avoiding the sun and fluorescent light: Lupus skin lesions are extremely sensitive to natural and artificial light, so you should limit your exposure. Stay inside when the sun is strongest during the day, and wear a wide-brimmed hat, sun-protective clothing and sunscreen when you cant avoid the sun.
- Injections: Your provider may use a needle to inject a corticosteroid medication directly into the rash. Steroid injections reduce inflammation. You may need these injections every few weeks.
- Oral medications: Healthcare providers have used a drug called hydroxychloroquine to treat systemic lupus for many years. It controls your bodys immune response. You may also need other drugs that suppress the immune system, such as methotrexate.
- Topical medications: Creams, lotions and ointments can reduce inflammation on the skin. You may need to apply these to your skin once or twice a day. Types of topical medications include corticosteroid creams and tacrolimus ointment .
You should see your provider regularly so they can monitor your health and adjust treatment. Since you will need to avoid the sun, your vitamin D levels might drop below normal levels. Your provider may prescribe vitamin D supplements.
How Is Lupus Treated
Treatment for lupus depends on the organs involved. There is no cure for it, but treatment can help control symptoms. Often, a patient with lupus has a health care team with specialists such as:
- a rheumatologist
- an infectious disease specialist
- a dermatologist
- a social worker
Medicines can help lower the risk of flares and improve symptoms. Someone with lupus may take:
- corticosteroids to control inflammation
- immunosuppressive drugs to lower the body’s immune response
- antimalarial drugs to help treat skin rashes and joint pain
- acetaminophen or nonsteroidal anti-inflammatory drugs , such as ibuprofen or naproxen, for joint and muscle pain
Doctors may also recommend that people with lupus:
- Avoid the sun as much as possible and wear sunscreen and protective clothing when outside to help reduce the number of flares.
- Get regular exercise to help with tiredness and joint stiffness.
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Detecting Silent Lupus Signs Early On
Systemic lupus erythematosus is the most common form of lupus and often appears in the form of early symptoms of fatigue and achiness before being diagnosed.
Lupus is an autoimmune disorder that causes the body to attack itself. Though there are common symptoms amongst lupus patients, symptoms do vary case by case.
What Is Livedo Reticularis
Livedo reticularis refers to various conditions in which there is mottled discoloration of the skin characterized by transient or persistent, blotchy, reddish-blue to purple, net-like cyanotic pattern 14). It is described as being reticular , as cyanotic discolouration surrounds pale central skin. Livedo reticularis itself is relatively benign. However, thromboembolic disease due to associated conditions such as antiphospholipid syndrome may lead to serious arterial events including the death of the patient.
Livedo reticularis may be differentiated into five distinct entities based on duration of the livedo pattern and its association with ambient temperature:
Broadly speaking, livedo is divided into physiological and pathological livedo reticularis. Physiological livedo reticularis is commonly seen on the legs of infants and young women in cold weather and improves on rewarming. Pathological livedo reticularis is a cutaneous manifestation of a number of systemic conditions, most notably the antiphospholipid syndrome , and is associated with arterial and venous thrombosis and increased pregnancy morbidity irrespective of the presence of antiphospholipid antibodies.
Cutis marmorata causes temporary or physiological livedo in about 50% of normal infants and many adults, particularly young women when exposed to the cold.
Secondary livedo or livedo racemosa, is associated with a range of systemic diseases.
Figure 7. Livedoid vasculopathy
Figure 8. Idiopathic livedo reticularis
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