It is with great interest that we read the article in the July 1995 issue of the Archives by Somach et al1 concerning fatal cutaneous necrosis mimicking calciphylaxis in a patient with type 1 primary hyperoxaluria. This case is remarkable for several reasons.
First, this case shows that no clear distinction is often made between livedo reticularis and livedo racemosa. Livedo reticularis is a fine, regular netlike patterning of the skin, usually arising after the extremities have been exposed to cold and clearing after they have been warmed. The classic example is seen in cutis marmorata, but numerous neurohumoral and blood viscosity disturbances such as polyglobulia, cold agglutinin disease, and paraproteinemia may also display this symptom.2 In contrast, the skin in livedo racemosa displays an irregular netlike pattern with broken circular segments resulting in a seemingly larger pattern that persists when the skin is warmed. The classic example
Plörer A, Zelger B. Acute Livedo Racemosa in a Patient With Type 1 Primary Hyperoxaluria. Arch Dermatol. 1996;132(3):349. doi:10.1001/archderm.1996.03890270127022