CUTIS MARMORATA
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I have a 23 yo WF with "white spots on the legs" which actually turned out 
to be reticulated hyperemia ie cutis marmorata.  She is fair skinned.
The splotchiness is asymptomatic, but the 4-6mm central white spots are   
very pronounced and get worse when the patient is standing -- as bad as
I have ever seen.  She is concerned about the appearance.  ANF was neg- 
ative. Any suggestions for treatment other than makeup? (Has anyone had 
luck with NTG paste?-- we were reluctant to try it because it involves
both lower extremities and with the high surface area headaches might be
a problem...) thanks in advance

R Berger MD
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If you are dealing with livedo reticularis rather than cutis marmorata, 
you might want to undertake a work-up for some of the underlying causes, 
those conditions which may cause slower blood flow.  These include 
physical obstruction as well as conditions such as Waldenstroms 
hypergammaglobulinemia and a host of others that result in increased blood 
viscosity, antigen antibody complex disease, etc.

Art Huntley MD
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I would recommend self-tanning lotion.  It is simple to apply and 
browns the skin.  Have you ever seen cutis marmorata in a tanned
person?

Rhett Drugge, M.D.
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I have had two patients in their 20s with livedo who have had the
antiphospholipid syndrome.  Rather banal livedo showed vascular thrombosis 
on biopsy.  Also, does this pt have livedo/cutis marmorata or so-called
vasospastic macules. I believe calcium channel blockers have been said to
help.

Christopher Dabski, M.D.
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Trental, 400 mg po TID with meals is the treatment of choice. Use it for 
6 to 8 months before adding Diltiazem if the cutis marmorata hasn't 
resolved by then. The condition returns when the Trental is stopped. 

Haines ELy, 
Grass Valley, Ca.
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The recent inquiry regarding management of "bad cutis marmorata" raises the
(?related) issue of patients who present with multiple anemic macules on a
pink background of normally vascularized skin on arms and legs.  These
resemble the anemic macules occasionally seen around vascular spiders during
pregnancy.  I've seen several such cases in young women, and one striking
case in a young man presented at the Seattle Derm Society.  I did run across
one article on this condition (I believe in Arch Derm) but treatment was not
mentioned.  I've had no luck with either nifedipine (to get the white out) 
or with nadolol (to get the red out).  Is this a treatable physiologic 
entity?

Mark Valentine MD
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