Livedo racemosa secondary to hyaluronic acid injection

Iatrogenic vascular occlusion secondary to filler injection, such as with hyaluronic acid, is a known but rare, entity. It typically occurs in the setting of facial cosmetic procedures but has also been described in the setting of osteoarthritis. We present a patient with ankle osteoarthritis who developed an asymmetric, reticular, livedoid eruption after intra-articular injection with hyaluronic acid. She was diagnosed with livedo racemosa secondary to vascular occlusion and placed on low-molecular weight heparin. Later, a transition to low-dose daily aspirin maintained the improvement.