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Antiphospholipid Syndrome — SCE Dermatology MCQ

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HardConnective Tissue & VasculitisAntiphospholipid SyndromeSCE Dermatology

A woman with antiphospholipid antibodies has a persistent violaceous network over the trunk and limbs. The rings are irregular, broken and do not disappear on warming. Which interpretation is most accurate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Livedo racemosa, suggesting an underlying occlusive vasculopathy such as APS

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

D is correct. Livedo racemosa forms a persistent, irregular and incomplete branching network and is associated with pathological occlusive states including antiphospholipid syndrome. Physiological cutis marmorata and primary livedo reticularis are usually regular and improve with warming. Erythema ab igne follows repeated heat exposure and develops fixed reticulate pigmentation. Retiform purpura reflects vessel occlusion with non-blanching purpura and often necrosis, which are not described. The morphology should prompt assessment for thrombotic history and systemic vascular disease rather than be dismissed as cold mottling.

Reference: DermNet livedo reticularis and racemosa review: https://dermnetnz.org/topics/livedo-reticularis