Don't Overlook Reticularis Implications.

SAN FRANCISCO -- It's no secret that livedo reticularis can be a symptom of antiphospholipid syndrome, yet many clinicians still miss the diagnostic implications of this peculiar rash, Dr. T. Murphy Goodwin said.

The netlike rash virtually clinches the diagnosis in a woman with suspected antiphospholipid syndrome. Laboratory testing almost always shows serologic abnormalities to support the clinical diagnosis in these cases, he said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

Every few months at his hospital, however, clinicians see a woman with a history of fetal loss or venous thrombosis--other diagnostic clues to the disorder--and will note the presence of livedo reticularis in the chart without recognizing the very strong association of the rash with antiphospholipid syndrome, said Dr. Goodwin, chief of maternal-fetal medicine at Women's and Children's Hospital, Los Angeles.

The appearance of the netlike rash worsens in cold temperatures. It does not itch or bother the patient. In otherwise healthy women, livedo reticularis may be benign, but in women with other symptoms of antiphospholipid syndrome, it's a sign of a larger problem, said Dr. Goodwin, also of the University of Southern California, Los Angeles.

Antiphospholipid syndrome is a spectrum of thrombotic events and thrombocytopenia. Most patients have primary ...