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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1993 Mar;52(3):219–222. doi: 10.1136/ard.52.3.219

Cutaneous manifestations associated with antiphospholipid antibodies in patients with suspected primary antiphospholipid syndrome: a case-control study.

L Naldi 1, F Locati 1, L Marchesi 1, S Cortelazzo 1, G Finazzi 1, M Galli 1, A Brevi 1, T Cainelli 1, T Barbui 1
PMCID: PMC1005021  PMID: 8484676

Abstract

OBJECTIVE: To study the association of a variety of dermatological manifestations related to vascular abnormalities with antiphospholipid antibodies in patients with suspected primary antiphospholipid syndrome. METHOD: Case-control study. Consecutive patients referred to the coagulation and haemostasis service of a general hospital for the first determination of antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) and newly diagnosed disorders (for example, thrombocytopenia, thrombotic disorders, and unexplained repeated abortions) were selected. Patients were examined by two dermatologists according to predefined criteria, and information about general characteristics and relevant dermatological and medical histories were collected using an ad hoc questionnaire. The study was limited to patients without evidence of systemic lupus erythematosus. A total of 35 patients was examined; 13 subjects were positive for lupus anticoagulant or anticardiolipin antibodies, or both (cases), and 22 were negative (controls). RESULTS: Moderate to severe livedo reticularis and acrocyanosis were significantly associated with antiphospholipid antibodies, with relative risks of 13.1 (95% confidence interval 1.1 to 149.0) and 8.6 (95% confidence interval 1.1 to 65.1). Capillaritis was also associated with the antibodies. Histories of Raynaud's phenomenon and superficial thrombophlebitis were more common in cases than controls. CONCLUSIONS: This study provides quantitative evidence of the association of antiphospholipid antibodies with several cutaneous diseases in which vascular abnormalities seem to play a major part. The study suggests that these manifestations might appear early in the development of the antiphospholipid syndrome.

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Selected References

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  1. Asherson R. A., Cervera R. The antiphospholipid syndrome: a syndrome in evolution. Ann Rheum Dis. 1992 Feb;51(2):147–150. doi: 10.1136/ard.51.2.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Copeman P. W. Livedo reticularis. Signs in the skin of disturbance of blood viscosity and of blood flow. Br J Dermatol. 1975 Nov;93(5):519–529. doi: 10.1111/j.1365-2133.1975.tb02244.x. [DOI] [PubMed] [Google Scholar]
  3. Englert H. J., Loizou S., Derue G. G., Walport M. J., Hughes G. R. Clinical and immunologic features of livedo reticularis in lupus: a case-control study. Am J Med. 1989 Oct;87(4):408–410. doi: 10.1016/s0002-9343(89)80823-x. [DOI] [PubMed] [Google Scholar]
  4. Galli M., Comfurius P., Maassen C., Hemker H. C., de Baets M. H., van Breda-Vriesman P. J., Barbui T., Zwaal R. F., Bevers E. M. Anticardiolipin antibodies (ACA) directed not to cardiolipin but to a plasma protein cofactor. Lancet. 1990 Jun 30;335(8705):1544–1547. doi: 10.1016/0140-6736(90)91374-j. [DOI] [PubMed] [Google Scholar]
  5. Hamsten A., Norberg R. Antibodies to phospholipids in thrombotic disease. J Intern Med. 1989 Jun;225(6):363–365. doi: 10.1111/j.1365-2796.1989.tb00097.x. [DOI] [PubMed] [Google Scholar]
  6. Hamsten A., Norberg R., Björkholm M., de Faire U., Holm G. Antibodies to cardiolipin in young survivors of myocardial infarction: an association with recurrent cardiovascular events. Lancet. 1986 Jan 18;1(8473):113–116. doi: 10.1016/s0140-6736(86)92258-0. [DOI] [PubMed] [Google Scholar]
  7. Harris E. N., Gharavi A. E., Hughes G. R. Anti-phospholipid antibodies. Clin Rheum Dis. 1985 Dec;11(3):591–609. [PubMed] [Google Scholar]
  8. Harris E. N., Hughes G. R. Standardising the anti-cardiolipin antibody test. Lancet. 1987 Jan 31;1(8527):277–277. doi: 10.1016/s0140-6736(87)90099-7. [DOI] [PubMed] [Google Scholar]
  9. Hughes G. R., Harris N. N., Gharavi A. E. The anticardiolipin syndrome. J Rheumatol. 1986 Jun;13(3):486–489. [PubMed] [Google Scholar]
  10. Katayama I., Otoyama K., Kondo S., Nishioka K., Nishiyama S. Clinical manifestations in anticardiolipin antibody-positive patients with progressive systemic sclerosis. J Am Acad Dermatol. 1990 Aug;23(2 Pt 1):198–201. doi: 10.1016/0190-9622(90)70198-q. [DOI] [PubMed] [Google Scholar]
  11. Loizou S., McCrea J. D., Rudge A. C., Reynolds R., Boyle C. C., Harris E. N. Measurement of anti-cardiolipin antibodies by an enzyme-linked immunosorbent assay (ELISA): standardization and quantitation of results. Clin Exp Immunol. 1985 Dec;62(3):738–745. [PMC free article] [PubMed] [Google Scholar]
  12. Malia R. G., Greaves M., Rowlands L. M., Lawrence A. C., Hume A., Rowell N. R., Moult J., Holt C. M., Lindsey N., Hughes P. Anticardiolipin antibodies in systemic sclerosis: immunological and clinical associations. Clin Exp Immunol. 1988 Sep;73(3):456–460. [PMC free article] [PubMed] [Google Scholar]
  13. Morton K. E., Gavaghan T. P., Krilis S. A., Daggard G. E., Baron D. W., Hickie J. B., Chesterman C. N. Coronary artery bypass graft failure--an autoimmune phenomenon? Lancet. 1986 Dec 13;2(8520):1353–1357. doi: 10.1016/s0140-6736(86)92004-0. [DOI] [PubMed] [Google Scholar]
  14. Naldi L., Finazzi G., Brevi A., Cavalieri d'Oro L., Locati F., Marchesi L., Cainelli T., Barbui T. Antiphospholipid antibodies and melanoma: a link? Dermatology. 1992;184(2):156–156. doi: 10.1159/000247529. [DOI] [PubMed] [Google Scholar]
  15. Page E. H., Shear N. H. Temperature-dependent skin disorders. J Am Acad Dermatol. 1988 May;18(5 Pt 1):1003–1019. doi: 10.1016/s0190-9622(88)70098-5. [DOI] [PubMed] [Google Scholar]
  16. Ryan T. J., Copeman P. W. Microvascular pattern and blood stasis in skin disease. Br J Dermatol. 1969 Aug;81(8):563–573. doi: 10.1111/j.1365-2133.1969.tb16039.x. [DOI] [PubMed] [Google Scholar]
  17. Sontheimer R. D. The anticardiolipin syndrome. A new way to slice an old pie, or a new pie to slice? Arch Dermatol. 1987 May;123(5):590–595. doi: 10.1001/archderm.123.5.590. [DOI] [PubMed] [Google Scholar]
  18. Stephens C. J. The antiphospholipid syndrome. Clinical correlations, cutaneous features, mechanism of thrombosis and treatment of patients with the lupus anticoagulant and anticardiolipin antibodies. Br J Dermatol. 1991 Sep;125(3):199–210. doi: 10.1111/j.1365-2133.1991.tb14741.x. [DOI] [PubMed] [Google Scholar]
  19. Sturfelt G., Nived O., Norberg R., Thorstensson R., Krook K. Anticardiolipin antibodies in patients with systemic lupus erythematosus. Arthritis Rheum. 1987 Apr;30(4):382–388. doi: 10.1002/art.1780300404. [DOI] [PubMed] [Google Scholar]
  20. Weinstein C., Miller M. H., Axtens R., Buchanan R., Littlejohn G. O. Livedo reticularis associated with increased titers of anticardiolipin antibodies in systemic lupus erythematosus. Arch Dermatol. 1987 May;123(5):596–600. [PubMed] [Google Scholar]

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