Mottled Skin

What is mottled skin?

Mottled skin is usually a temporary condition. It occurs when blood flow to tiny vessels under your skin is disrupted. This results in a fine, bluish-red, lace-like pattern (reticula). The condition is also known as livedo reticularis.

What is livedo racemosa vs. reticularis?

A similar condition, livedo racemosa, also results in a lace-like pattern on your skin. Livedo racemosa occurs when there’s a permanent disruption to blood flow. It results in larger reticula with broken circular segments.

What are the main types of livedo reticularis?

The three main types are:

• Physiologic: This temporary, harmless condition — also called cutis marmorata — is due to cold exposure. It goes away when your skin warms up. Mottled skin when cold typically affects infants, children and young women and people assigned female at birth (AFAB) with lighter skin.
• Primary livedo reticularis: This type of mottled skin occurs when blood vessels just below your skin’s surface suddenly constrict for unknown reasons. It’s temporary and unrelated to temperature changes. Primary livedo reticularis is diagnosed when underlying conditions have been ruled out.
• Secondary livedo reticularis: Skin mottling occurs as a complication of underlying medical conditions. These include vascular disease, neurological disorders, certain cancers and infections. Secondary livedo reticularis is persistent, meaning that it doesn’t go away until the underlying condition is diagnosed and treated.

Are there other types of livedo reticularis?

Yes. Other types include:

Congenital livedo reticularis

This condition (also called cutis marmorata telangiectatica congenita) occurs at birth and typically forms on a hand or foot. Congenital livedo reticularis may be associated with anomalies in other areas of the body, including your:

• Brain, nerves and spinal cord.
• Eyes.
• Heart and vascular system.
• Skull and face.

Erythema ab igne

A reticular pattern forms due to extended heat exposure. It may stem from a:

• Laptop that overheats in your lap.
• Heating pad pressed against your skin for an extended period.
• Fireplace or other contained heat source.
• Long, hot shower.

Idiopathic livedo reticularis

This type occurs when healthcare providers have ruled out an underlying condition and determined that there’s no known cause (idiopathic). Idiopathic livedo reticularis is persistent, meaning that it may be present for a long time.

Livedo racemosa

This is a secondary type of livedo reticularis. It occurs in about 25% of patients with primary antiphospholipid syndrome (APS) and up to 70% of those with lupus-associated APS.

What are possible livedo reticularis causes?

The primary cause is decreased blood flow to your skin. When this occurs, oxygen-poor blood from tiny blood vessels pools under your skin. Mottled skin can have many other causes, including:

Autoimmune and connective tissue disorders

Autoimmune and connective tissue disorders that can lead to mottled skin include:

• Dermatomyositis.
• Fibromyalgia.
• Lupus.
• Rheumatoid arthritis.
• Sjögren syndrome.

Cancer

Cancerous growths can cause mottled skin if they disrupt blood flow. They include:

• Acute lymphocytic leukemia.
• Chronic lymphocytic leukemia.
• Inflammatory breast cancer.
• Kidney cancer.
• Multiple myeloma.
• Mycosis fungoides.

End of life

Mottled skin before death occurs because circulation is slowing. In this situation, reticula are accompanied by other end-of-life symptoms, including difficulty breathing.

Infectious disease

Infectious diseases that cause livedo reticularis include:

• Atypical (walking) pneumonia.
• Brucellosis.
• Hepatitis C.
• Meningococcal disease.
• Rheumatic fever.
• Syphilis.
• Tuberculosis.

Medication reactions

Mottled skin can be a side effect of certain medications, including:

• Bismuth.
• Erythromycin.
• Gemcitabine.
• Heparin.
• Interferon beta-1b.
• Minocycline.

Neurological conditions

Conditions affecting peripheral nervous system functioning (nerves outside your brain and spinal cord) can cause livedo reticularis. These include:

• Complex regional pain syndrome.
• Multiple sclerosis (MS).
• Parkinson disease.
• Susac syndrome.

Vascular disorders

Many vascular disorders cause mottled skin. Some are due to narrowed blood vessels, others because of blockages. They include:

• Antiphospholipid syndrome.
• Antithrombin deficiency.
• Cryoglobulinemia.
• Deep vein thrombosis (DVT).
• Hyperoxaluria.
• Polyarteritis nodosa.
• Polycythemia vera.
• Protein C deficiency.
• Protein S deficiency.
• Temporal arteritis.
• Thrombocytosis.

How is mottled skin diagnosed?

Healthcare providers diagnose livedo reticularis by looking at your skin. They may review your health history and any chronic illnesses you’ve had. You may also need a skin biopsy or lab studies, such as urinalysis or blood tests.

What types of livedo reticularis treatment might I need?

The best therapy for you depends on the type:

• Primary livedo reticularis: Gradually warm the affected area by taking a shower or bath.
• Secondary livedo reticularis: Symptoms should improve by treating the underlying condition. For example, a vascular condition may require anticoagulants.
• Congenital livedo reticularis: This condition goes away on its own but may take time.
• Erythema ab igne: Moving away from the heat source is typically all that’s necessary. For lingering symptoms, you may need medicated cream, such as fluorouracil.
• Idiopathic livedo reticularis: Elevating the affected limb or wearing compression garments can improve blood flow.

What can I do to prevent mottled skin?

You can prevent certain types, like primary livedo reticularis, by not exposing your skin to cold environments. Secondary livedo reticularis may be more challenging to prevent. If you have a condition that puts you at risk for mottled skin, it’s essential to follow care instructions closely.

Contact your healthcare provider if you notice a dark lace-like pattern on your skin. Since livedo reticularis can be a sign of many medical issues, a timely assessment is essential. This information helps your provider determine the cause so that you can receive treatments, if necessary.

What does mottled skin look like?

The condition causes patches of discoloration in a lace-like pattern, with pale skin at the center. The reticula may be reddish-blue or purple and may come and go. Symptoms often affect only certain areas of your body, like your lower limbs.

A note from Cleveland Clinic

Livedo reticularis is often a harmless skin reaction to cold environments. Your outlook depends on the type and cause. Primary livedo reticularis often goes away shortly after warming the affected area. Secondary livedo reticularis is likely to go away with treatment for the underlying medical issue.