People typically use the phrase “mottled skin” to describe livedo reticularis, a condition that causes a blotchy or web-like pattern of red, blue, or purple lines to appear across the skin. In very deep skin tones, the pattern may be a dark brown.

Livedo reticularis may be the result of reduced blood flow to an area of the skin. This can be due to a reaction to cold temperatures, a medical condition symptom, or a medication’s side effect. In some cases, livedo reticularis is idiopathic, which means doctors cannot identify a cause.

Because mottled skin is not a medical term, people may also use this to describe several other skin conditions and rashes. This article will focus on mottled skin caused by livedo reticularis.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Mottled skin is a net or web-like pattern on the skin. This pattern will usually appear red, bluish, purple, or brown.

Researchers believe that mottled skin develops when there is a lack of blood flow to the skin. This may mean more deoxygenated blood is under the skin’s surface, which causes the vivid web- or lace-like pattern.

The medical name for this symptom is livedo reticularis.

The main types of livedo reticularis are:

  • Physiologic livedo reticularis/cutis marmorata: A temporary reaction to the cold that comes and goes. It commonly affects children and babies, but may also affect adults.
  • Primary or idiopathic livedo reticularis: Mottled skin that does not have a cause.
  • Secondary livedo reticularis: Mottled skin caused by an underlying condition.

If the rash is associated with systemic symptoms, doctors must check whether the rash is livedo reticularis or livedo racemosa, a related condition that also causes mottling. Livedo racemosa is always the result of an underlying condition and has a strong association with antiphospholipid syndrome (APS).

Many things can reduce the flow of oxygenated blood to the skin, so many things can cause livedo reticularis. Doctors sort cases into different categories to make it easier to understand the potential causes.

Below are a few of the causes associated with mottled skin.

Cold

Physiologic livedo reticularis, or cutis marmorata, can occur when blood vessels constrict in response to the cold. As the skin warms up, the blood vessels open again, which leads to the mottled skin clearing up.

This can affect both adults and children, but it is more common in children and young women.

This is a harmless condition that does not require treatment. People can reduce their symptoms by warming their skin.

Antiphospholipid syndrome

Rarely, idiopathic livedo reticularis can be an early symptom of an autoimmune condition known as antiphospholipid syndrome (APS) and is associated with a low blood count (thrombocytopenia).

APS, or Hughes syndrome, is an autoimmune condition that mostly affects young to middle-aged adults. In this condition, abnormal antibodies can lead to abnormal micro blood clots, which decrease blood flow and increase the risk of stroke and pulmonary embolism.

Mottled skin, along with red or purple skin patches, is a common symptom of APS. A person may also develop:

  • blood circulation problems
  • blood clots
  • leg ulcers

Research also shows that APS can be an underlying condition in people with Snedden syndrome, a disorder in which abnormal clotting leads to neurological symptoms. This condition can also cause mottled skin.

People who have APS also have an increased risk of developing deep vein thrombosis. For this reason, many people with this diagnosis need blood-thinning medications to help prevent dangerous blood clots.

Other underlying conditions

The causes of secondary livedo reticularis are usually underlying diseases or disorders. These include:

Thyroid disease

According to research, thyroid gland diseases, including hypothyroidism, may cause mottled skin.

Hypothyroidism may also cause:

  • unexplained weight gain
  • low energy
  • sensitivity to cold
  • depression

Diseases affecting the parathyroid gland may also cause mottled skin, especially when blood vessels calcify, damaging circulation.

Treatment for thyroid disease focuses on correcting a person’s thyroid hormone levels. People with hypothyroidism will need to take synthetic thyroid hormones.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is another potential cause of mottled skin. It is an autoimmune disease that causes joint pain and inflammation.

It may also cause dark, patchy, or mottled skin, which may be due to the way the inflammatory condition affects the blood vessels.

Other symptoms of RA include:

  • fatigue
  • a low fever
  • pain and stiffness that lasts for more than 30 minutes
  • anemia
  • weight loss
  • firm lumps or nodules beneath the skin in the hands, elbows, or ankles

There is no cure for RA, but treatment can reduce the symptoms and the risk of joint damage. Doctors can prescribe disease-modifying antirheumatic drugs (DMARDs), biologics, and pain medications to reduce autoimmune activity and manage people’s symptoms.

COVID-19

Research shows that livedo reticularis can be a symptom of COVID-19.

A 2020 case study notes that skin symptoms may occur in as many as 20% of people with COVID-19. In some cases, livedo reticularis-like rashes may be an early COVID-19 symptom or the only symptom of presumed infection.

Doctors do not know what specifically caused the rashes in these people. It may be part of an immune reaction or related to new medications for COVID-19.

Other symptoms of COVID-19 include:

  • fever
  • chills
  • a cough
  • a new loss of taste or smell
  • feeling short of breath
  • fatigue
  • body aches
  • a sore throat
  • congested or runny nose
  • nausea
  • vomiting
  • diarrhea
  • a headache

If someone could have COVID-19, they need to remain at home and seek testing from their local health authority, even if their symptoms are mild. Most cases of COVID-19 improve on their own without treatment, but people must seek emergency help if someone develops:

  • difficulty breathing
  • blue or white lips
  • new confusion
  • pain or pressure in the chest
  • difficulty staying awake

A person can receive a vaccine against COVID-19.

Learn more about what to do if someone has COVID-19 symptoms.

Acute pancreatitis

Mottled skin is a secondary and rare symptom of acute pancreatitis. This condition happens when the pancreas becomes inflamed for a short period.

A person with acute pancreatitis can get mottled skin. The other symptoms include:

  • severe abdominal pain
  • nausea
  • fever
  • vomiting
  • diarrhea

Treatments for acute pancreatitis include intravenous (IV) fluids and anti-inflammatory medication. Lifestyle changes may also help prevent it from coming back.

Lupus

Lupus is an autoimmune inflammatory condition in which the immune system begins attacking healthy tissue. If lupus causes damage to the small blood vessels, a person with this condition may develop livedo reticularis.

Other symptoms of lupus include:

There is no cure for lupus, although treatment can help manage symptoms. Some options include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and immunosuppressants. Lifestyle changes such as managing stress and quitting smoking may also help ease symptoms.

Septic shock

Mottled skin may be a sign that a person’s body is in septic shock. Septic shock is a medical emergency in which bacteria enter a person’s bloodstream. It causes sudden low blood pressure, leading to reduced blood flow to the skin. If left untreated, it can cause organ damage.

In addition to cold and mottled skin, symptoms of septic shock can include:

  • difficulty breathing
  • rapid heart rate
  • rapid breathing
  • nausea or vomiting
  • weakness
  • dizziness
  • fainting

If someone seems as though they are in septic shock, contact emergency services immediately.

Treatment may include oxygen, IV fluids, and further testing. A person may also need treatment for the underlying cause of their septic shock, usually an infection.

People should speak with a doctor if they have mottled skin and are not sure why. A doctor may:

  • perform a physical examination
  • take a complete medical history
  • request blood work to check for infections and illnesses
  • perform a skin biopsy for further evaluation

A doctor will also ask when the symptoms began and if other symptoms are present to determine the source of the problem. For example, a person with an infection who seems confused may have septic shock, while a newborn baby may have developmentally typical skin mottling.

Depending on what is causing it, mottled skin is not always preventable. However, if someone has cutis marmorata or another condition that affects body temperature or circulation, taking steps to stay warm and boost blood flow may help.

People can try:

  • Staying active: Regular exercise can help improve circulation. Avoid sitting or lying down for long periods, wherever possible. If this is unavoidable, take regular breaks to stretch and move around. People with limited mobility may find it helpful to elevate their feet.
  • Keeping warm: Wearing multiple, light layers of clothing is a more effective way to stay warm than wearing just one thick layer. A blanket may help keep the legs and feet warm when sitting. Putting on gloves before going outside in cold weather traps warm air.
  • Reducing pressure on the extremities: Try to avoid putting weight on the arms or legs for long periods. For example, if someone often sits with their legs crossed, they could try uncrossing them to allow blood to flow more easily. Wearing tight clothing may also reduce blood flow, so aim for clothes that fit but do not dig in.
  • Massage: Massage can help stimulate circulation. A person can visit a professional for this or learn self-massage techniques.
  • Maintaining hydration: Making sure a person drinks enough water can help support healthy blood flow.
  • Stress reduction: When a person experiences stress, it can cause the blood vessels to narrow and restrict blood flow. Therefore, managing a person’s stress is a good prevention strategy.
  • Quitting smoking: Smoking can also cause blood vessels to narrow, so a person should avoid it as well.

The following are answers to common questions about mottled skin.

Why does a baby have mottled skin?

Mottled skin in newborn babies is usually the result of cutis marmorata. It is a typical physiological response to cold temperatures and does not require treatment. Babies will usually grow out of cutis marmorata within a few weeks or months, but it can persist into adulthood. Rarely, mottled skin in babies can occur because of cutaneous marmorata telangiectatica congenita, a genetic condition that causes blood vessels to form differently than usual.

Why do some people get mottled skin before death?

The skin may appear mottled when a person is close to dying, particularly if it affects the upper extremities. Mottled skin may persist after someone dies because the heart stops pumping, so the circulation stops.

Should I worry about livedo reticularis?

A person with mottled skin may want to see a doctor who can rule out any underlying cause, especially if they are also experiencing other symptoms. However, in many cases, it may be a harmless symptom with no obvious cause or just a response to cold temperature.

Mottled skin is not harmful by itself. Some people develop this symptom when they are cold. Others have idiopathic livedo reticularis, meaning the mottled skin occurs on its own and has no clear cause.

Mottled skin can vary in severity. The more severe it is, the more likely it is that it is a symptom of another condition.

It is associated with thyroid disease, acute pancreatitis, and shock. If it is a sign of an underlying disorder, there will typically be other symptoms that occur alongside skin mottling.

People with mottled skin as a result of cold temperatures may be able to ease this symptom by boosting circulation and warming their skin. If warming their skin does not help, or the mottled skin is unconnected to temperature, it is a good idea to speak with a doctor.

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