Livedo Reticularis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats livedo reticularis?
A dermatologist (skin doctor) or a rheumatologist (joint and immune-system doctor) usually evaluates livedo reticularis, a blotchy, purplish, net-like pattern on the skin linked to swollen blood vessels. It is sometimes harmless, especially in cold weather, but it can also point to an underlying condition, so a primary care doctor may order tests to check for other causes.
What is livedo reticularis?
Livedo reticularis is a skin sign. It looks like a netlike pattern of reddish-blue skin color. The legs are often affected. The pattern is linked to swollen blood vessels. It may get worse in the cold.
There are two forms, called primary and secondary. Secondary livedo reticularis is also known as livedo racemosa. The skin pattern can be short-lived or long-lasting. A normal response to cold is called cutis marmorata. This is the common cause in infants.
Symptoms
Most often the legs are affected. Sometimes the face, trunk, buttocks, hands, and feet are involved too. Usually there is no pain. But if blood flow is completely blocked, pain and skin ulcers can develop. Ulcers are open sores.
Skin sores or lumps with the pattern can be a sign of vasculitis. This means inflamed blood vessels.
Causes and who gets it
In primary livedo reticularis, cold, tobacco use, or emotional upset can bring on the skin change. Women 20 to 50 years old are most often affected.
The pattern comes from skin veins that hold more blood than normal. Enlarged veins or blocked blood flow out of the veins can cause this.
Many diseases are linked to secondary livedo reticularis, such as:
- A reaction to certain medicines, such as amantadine or interferon.
- Blood vessel diseases, such as polyarteritis nodosa and Raynaud phenomenon.
- Blood diseases, such as abnormal proteins or a high risk of blood clots (antiphospholipid syndrome).
- Infections, such as hepatitis C.
- Paralysis, or a condition present at birth.
How doctors diagnose it
Your provider will ask about your symptoms. Blood tests or a skin biopsy may be done to help find any underlying health problem. A skin biopsy is a test that takes a small sample of skin.
A medical review says doctors ask where the pattern appears. They ask how the temperature changes it and how long each attack lasts. They also ask about autoimmune disease, which is when the body attacks itself. They ask about blood clots and new nerve symptoms.
A lupus anticoagulant panel is a blood test. It is worth considering when cold is not clearly the only cause. It looks for antibodies tied to clotting problems.
Treatment
For primary livedo reticularis, keeping warm, especially the legs, may help relieve the skin color change. Do not smoke. Avoid stressful situations. If you are uncomfortable with how your skin looks, talk to your provider about treatment.
A medical review says primary livedo reticularis needs no medical treatment other than avoiding cold.
For secondary livedo reticularis, treatment depends on the underlying disease. For example, if blood clots are the problem, your provider may suggest blood thinning medicines.
In many cases, primary livedo reticularis improves or goes away with age. If a disease is the cause, the outlook depends on how well it is treated.
When to see a doctor
Contact your provider if you think your livedo reticularis may be due to an underlying disease. Pain or skin sores can develop if blood flow is completely blocked, so tell your provider about them.
Call 911 or go to the emergency room if you have chest pain, trouble breathing, or fainting. Do the same for sudden weakness or a change in vision.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care doctor can ask about your symptoms and order blood tests to help find an underlying problem.
Common questions
Is livedo reticularis dangerous?
Livedo reticularis is often harmless, especially when it appears mostly in cold weather and fades with warming. In some cases it can be linked to conditions affecting blood vessels or the immune system, so a doctor may check for other causes.
Can a direct primary care doctor manage livedo reticularis?
A direct primary care doctor can ask about your symptoms and order blood tests to look for underlying causes.
What causes the skin pattern in livedo reticularis?
The mottled pattern happens when blood flow through small vessels in the skin is disturbed. In the form linked to cold, the vessels narrow (a spasm) and the color change is reversible. In some people, it is linked to conditions that affect blood clotting or the immune system, which a doctor can test for.
Sources
- MedlinePlus - Livedo reticularis
- National Library of Medicine (PubMed Central) - Livedo reticularis: A review of the literature
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
