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Retinal livedo (Melkersson-Rosenthal syndrome): causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Livedo reticularis (Melkerson-Rosenthal syndrome) was first described in 1928 by Melkersson. He observed a patient with recurrent facial nerve paresis and persistent lip edema, and in 1931 Rosenthal added a third symptom - folded or scrotal tongue.
Causes of reticulated livedo
The causes and pathogenesis of the disease have not been fully studied. Some authors classify it as infectious-allergic, since the dermatosis begins or recurs after infectious diseases (tonsillitis, flu, simple vesicular lichen, etc.). Preceding factors may also include trauma, functional disorders of the peripheral and central nervous system.
Symptoms of reticulated livedo
Symptoms of reticular levido. Melkersson-Rosenthal syndrome is more common in women. It includes a triad of symptoms: facial nerve paralysis, macrocheilitis, and tongue folds.
The disease usually begins in childhood or adolescence, rarely in adults. The first symptom is facial nerve paresis, which over time transforms into unilateral facial nerve paralysis of varying severity.
The second clinical sign of Melkersson-Rosenthal syndrome is macrocheilitis, which develops due to lip swelling and infiltration. The lips are thickened and everted, have a dense, less often - doughy-elastic consistency, moderately tense, no pit remains when pressed. The lip resembles elephantiasis, its edges do not fit tightly to the teeth, without signs of inflammation and regional lymphadenitis. As a result of swelling of the lips of varying intensity, a clear asymmetry of the face occurs.
The third sign is scrotal tongue. The tongue surface, permeated with folds, becomes bumpy and can become keratinized in places. Such a hypertrophied folded tongue becomes less mobile.
Melkersson-Rosenthal syndrome may occur not only as a three-symptom syndrome, but also as macrocheilitis in combination with unilateral facial nerve paralysis. Sometimes macrocheilitis is the only symptom of the disease.
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Differential diagnosis
If Melkersson-Rosenthal syndrome is manifested by macrocheilitis alone, it must be differentiated first of all from elephantiasis, which occurs with chronic erysipelas, and Quincke's edema.
Treatment of reticulated livedo
Complex treatment is carried out, including corticosteroids (25-30 mg per day orally), broad-spectrum antibiotics, antimalarials, antihistamines, vitamins. Externally - physiotherapy (UHF, darsonval, etc.).