Correspondence |

Livedo Reticularis and Skin Necrosis Due to Hyaluronic Acid Embolism

Paloma Borregón-Nofuentes, MD; José Antonio Avilés-Izquierdo, PhD; M. Ángeles Martínez-Izquierdo, MD; Lucas Ribé-Bernal, MD; Ana Pulido-Pérez, MD; M. Dolores Moya-González, MD; Pablo Lázaro-Ochaita, PhD
JAMA Dermatol. 2013;149(3):373-375. doi:10.1001/jamadermatol.2013.1361.
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Correspondence: Dr Borregón-Nofuentes, Department of Dermatology, Clinica Universidad de Navarra en Madrid. Calle General López Pozas 10, 28036 Madrid, Spain (paloma_borregon@hotmail.com).

Conflict of Interest Disclosures: None reported.

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Figure 1. Clinical images from our patient. A and B, Reddish-blue reticular pattern on the patient's right knee with 2 central necrotic areas. C, Skin without livedo reticularis 6 months after hyaluronic acid injection.

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Figure 2. Histopathologic images from the present case. A, Vascular proliferation in the reticular dermis and hypodermis with basophilic material inside the vessels; thickening of the intima can also be observed (hematoxylin-eosin, original magnification ×4). B, Detail of an occluded vessel (hematoxylin-eosin original magnification ×40). C and D, Hyaluronic acid inside blood vessels stained positively with Alcian blue stain at a pH of 2.5 (original magnifications ×10 [C] and ×20 [D]).




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