title: Chemical lumbar sympathectomy in the treatment of idiopathic livedo reticularis.
abstract: OBJECTIVE
  Livedo reticularis (LR) is a reticulated discoloration of the skin, particularly on lower extremities. Few treatment options are reported. This study investigated the efficacy and safety of chemical lumbar sympathectomy (CLS) in idiopathic LR. The key technique points of CLS are also illustrated in detail.
  
  
  METHODS
  Patients with idiopathic LR with a strong desire for treatment were recruited during a 2.5-year period. L3-4 CLSs were performed with 5% phenol (2 mL) in each injection site. The needle tip extends to approximately one-third of the vertical dividing line of the vertebral body. The contrast along the psoas muscle fibers indicates targeting on gray rami communicans instead of the sympathetic trunk. The primary efficacy variable was achieving "clear or almost clear" of LR lesions staying >1 hour in a 24°C air-conditioned room. Safety assessments included monitoring and recording of all adverse events and tolerability to treatment. The follow-up period was 2.5 to 4.7 years.
  
  
  RESULTS
  Ten women (median age, 22 years) were enrolled. Seven patients achieved "clear or almost clear" of LR lesions after CLS. The postoperative skin surface temperature increase was 7.4°C ± 2.6°C. Two patients achieved "major partially resolved," and one patient achieved "minor partially resolved." Two of the seven with "clear or almost clear" results reported recurrence ≤1 year during the follow-up, CLS was repeated, and they then achieved "clear or almost clear" again. Two patients reported mild pain localized to the thigh area, which resolved spontaneously by the second day.
  
  
  CONCLUSIONS
  This study showed CLS provides a valid option for the treatment of idiopathic LR. The efficacy of CLS can be long-lasting, and CLS can be repeated if LR recurs. Targeting at gray rami communicans, rather than the sympathetic trunk, is comparably effective and safer for sympathetic interruption.
authors.affiliation: Department of Dermatology, Peking University Third Hospital, Beijing, China.
authors.forename: Wen-Hui
authors.initials: WH
authors.lastname: Wang
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China. Electronic address: longzh2000@126.com.
authors.forename: Long
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: Jin-Man
authors.initials: JM
authors.lastname: Zhuang
authors.affiliation: Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.
authors.forename: Guo-Xiang
authors.initials: GX
authors.lastname: Dong
mesh_terms: D005260:Female; D006801:Humans; D054068:Livedo Reticularis / Q000628:therapy*; D013116:Spinal Cord; D013563:Sympathectomy, Chemical / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult