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Causes of Mottled Skin

Causes of Mottled Skin

Mottled skin is skin that looks patchy or irregularly coloured. Also called livedo reticularis, it can look like patches, streaks, or spots that are red or purple in colour. Mottled skin is usually nothing to worry about and clears up on its own, but in some cases, it may be caused by an underlying health condition. If you notice your skin looks mottled contact your doctor who will ask questions and examine you to check for any underlying causes. 

Last reviewed: 21/03/2023 by Dr Babak Ashrafi

Contents

What is mottled skin?

Mottled skin, also known as livedo reticularis, is patchy or irregular coloured skin. Signs of mottled skin can be reddish-purple streaks, spots or marks. There are several causes of mottled skin. Sometimes it can just be a result of being chilled or cold, a side effect of certain medication, or an underlying medical condition.

Mottled skin can affect any part of your body, and it can cause a marbling effect. In many cases, it may go away in time without any treatment, but you may need to see a doctor to check if this is caused by an underlying condition.

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Symptoms of mottled skin?

The most common sign of mottled skin is a blotchy appearance with red or purple spots. It can appear on any part of the body. Other symptoms of mottled skin can include:

  • irregular skin colour
  • lacy-looking network of patches on the skin
  • skin ulcers
  • painful nodules
  • red blotches
  • pins and needles in the affected area 

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Causes of mottled skin

There are many different causes of mottled skin, but two of the most common causes are circulatory problems and blood vessel spasms. In most cases, mottled skin is caused by a disturbance to the normal flow of blood to the skin.

Other causes include:

  • autoimmune conditions
  • circulatory problems
  • medication
  • infections
  • external temperature
  • cancer
  • shock 

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What skin conditions cause mottled skin?

In almost all cases of mottled skin, the cause is a disturbance in the usual blood flow to the skin. If the oxygen supply to skin cells is reduced, it can increase the amount of deoxygenated (without oxygen) blood reaching the area. This causes the skin to become discoloured. 

Although many skin conditions can change the appearance of your skin, such as eczema, dermatitis, and psoriasis, there aren’t many that cause your skin to mottle. Instead, some autoimmune conditions can cause mottled skin.

Autoimmune diseases are conditions that arise when the body’s immune system attacks healthy parts of your body. Many things can trigger a flare up of an autoimmune disease, such as:

  • viruses
  • some medicines
  • sunlight
  • life events such as puberty, childbirth, menopause

The autoimmune conditions that can cause mottled skin include:

  • Lupus
  • Antiphospholipid syndrome

Lupus

Lupus is a chronic autoimmune condition where the main characteristic is inflammation. It has been associated with mottled skin. Other signs of lupus include:

  • a butterfly rash on face
  • mouth sores
  • fatigue
  • headaches
  • breathing issues
  • joint pains and/or stiffness 

Antiphospholipid syndrome

Antiphospholipid syndrome is an autoimmune condition that affects the blood vessels. It can cause mottled skin to appear on your wrists or knees. Other signs or symptoms include:

  • blood clots
  • seizures
  • headaches
  • strokes
  • speech or memory problems

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What cancer can cause mottled skin?

There are some rare types of cancer that can affect the appearance of your skin, such as skin (cutaneous) lymphoma. This is a type of cancer that affects the lymphatic system in the body. It carries tissue fluid called lymph throughout the body, containing white blood cells that help to fight infections.

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Medications that can cause mottled skin

Mottled skin can be a side effect of some medications. Some medications that have been linked to causing mottled skin include:
  • amantadine - a  medication used to treat Parkinson’s Disease and shingles.
  • Catecholamines - are neurotransmitters and hormones the body uses to help maintain the nervous system. They include epinephrine, norepinephrine, and dopamine and are used to treat various diseases.
  • Minocycline (Minocin) is a type of antibiotic that works by stopping the growth and spread of bacteria. It is rarely used to treat acne.
  • Gemcitabine (Gemzar) is a chemotherapy drug used to treat bladder, breast, pancreatic, ovarian, and non-small cell lung cancer.
If you are concerned that your medication may be causing mottled skin, have a look at the patient information leaflet to see if it is a listed side effect and consult your doctor for advice.

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Infections that can cause mottled skin

Some severe infections can cause skin discolouration and mottling, including:
  • Tuberculosis 
  • Rheumatic fever
  • Sepsis
  • Meningitis

Tuberculosis

Tuberculosis (TB) is a bacterial infection that is usually spread by breathing in tiny droplets from the coughs and sneezes of an infected person. The infection usually affects the lungs but can affect other body parts. 

The infection can cause skin changes such as rashes, ulcers, and lumps to appear. Other symptoms may include:
  • a persistent cough and bringing up bloody phlegm
  • loss of appetite
  • breathlessness
  • fatigue
  • fever or high temperature

Rheumatic fever

Rheumatic fever is a rare complication of a bacterial throat infection. It can cause tiny bumps to appear under the skin, and the symptoms usually appear up to 5 weeks after you have had a throat infection.

Sepsis

Sepsis is a serious, life-threatening condition and can be difficult to spot because there are so many possible symptoms. Sepsis can sometimes look like other conditions like a chest infection or flu. 

Sepsis can cause your skin to change appearance. Some people with sepsis may develop a haemorrhagic rash, where clusters of tiny spots that look like pinpricks appear on the skin. It may also cause your skin to become blotchy.

If you suspect you or someone else may have sepsis, you should seek immediate medical help.

Meningitis

Meningitis is a serious infection that affects the protective membranes surrounding your brain and spinal cord, also called meninges. Although it can affect anyone, it is common in babies, young children, and adolescents. 

Symptoms of meningitis include:
  • fever
  • sickness
  • headache
  • stiff neck
  • being unable to tolerate bright lights
  • drowsiness
Another major symptom of meningitis is a skin rash. You can distinguish between a meningitis rash and one caused by sepsis by rolling a glass over it. If it does not fade, it can be a sign of meningitis.  If you or anyone you know have symptoms of meningitis you should seek medical help immediately.

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Other causes of mottled skin

Other causes of mottled skin include:
  • shock
  • pancreatitis
  • cold environment
  • end of life

Shock

Shock can be a cause of mottled skin. Shock is a life-threatening condition that occurs when there is a sudden drop in blood flow through the body. It can occur because of accidents, trauma, burns, and infections.

Other symptoms of shock include:
  • difficulty breathing
  • weakness
  • feeling or being sick
  • fast pulse
  • rapid breathing
  • dizziness
  • weakness 

Pancreatitis

Pancreatitis is a condition affecting the pancreas, a small organ that aids digestion. If you have pancreatitis, your pancreas will become inflamed, causing symptoms like:
  • aching in your tummy and back
  • feeling or being sick (vomiting)
  • fever
  • yellowing of the white’s of your eyes and skin (jaundice)
  • rapid breathing
  • fast heartbeat
Research also shows that some people may experience mottled skin with pancreatitis. Mottled skin usually goes away when the underlying pancreatitis is treated. 

Cold environment

Because cold temperatures can affect blood circulation, it is possible for the cold to cause mottled skin. Some people get hives from being exposed to cold temperatures, which can change the appearance of your skin and make it itchy or feel like it's burning or stinging.

End of life

Mottled skin can be a sign that someone is close to dying. Other symptoms can include:
  • difficulty swallowing
  • sleepiness
  • loss of appetite
  • delirium
  • noisy chest

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Mottled skin in children and babies

Mottled skin is usually apparent in some newborn babies and often goes away on its own. Mottling in babies and children usually describes skin that looks blue, blotchy, or pale. You may notice that other areas that aren’t affected by mottling may become lighter in colour than usual.

Although it is quite common in premature babies in neonatal units, if you notice your child’s skin looks different or unusual, speak to your doctor for advice to rule out any underlying causes. 

Why does it commonly affect young children/babies?

Often the cause of mottled skin in babies and young children is exposure to cold temperatures. If that’s the case, keep your child warm and away from the cold. If you are worried or unsure, speak to your doctor for advice.

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How to prevent mottled skin

There may be things you can do to help prevent mottled skin, especially if you know what’s causing it. For example, you may need to:
  • avoid cold temperatures or keep yourself warm
  • quit smoking if your mottled skin is being caused by circulation problems
  • eating a healthier diet, increasing your exercise, and making healthier choices to help reduce the risk of vascular disease or pancreatitis
  • speak to your doctor about the medications you take and if there are any alternatives

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Mottled skin treatment

The treatment for mottled skin will depend on the cause.

If your mottled skin is caused by cold temperatures, there is no treatment available other than avoiding the cold or keeping warm where possible. You may consider wearing warm clothes, using heated blankets, and putting the heating on in the room you are in.

If you have an underlying condition, such as an autoimmune condition causing mottled skin, then your doctor will likely prescribe medications that will help to control your immune response and reduce your symptoms. 

Vascular conditions or circulatory problems can be treated with medication to lower blood pressure or cholesterol levels. It will also help if you make some healthier lifestyle choices, such as eating a balanced diet and increasing your activity levels. Your symptoms should resolve once the underlying condition has been treated.

If mottled skin is caused by shock, then you will need immediate medical attention to determine the underlying cause.

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When to see a doctor

If mottled skin is unusual for you, you should see a doctor to find out what may be causing it. Sometimes it can be diagnosed just by looking at the skin, but if an underlying condition is suspected, you may need further tests.

You should seek medical advice if you have mottled skin and have any of the following symptoms:
  • feeling faint or dizzy
  • feeling or being sick
  • disorientation
  • confusion
  • slurred speech severe muscle pain
  • breathlessness
  • diarrhoea
  • not peeing as often as usual
  • fast heartbeat
  • fever 
These could be signs of sepsis or shock which can be life-threatening. If you think you or someone you know may be experiencing any of these symptoms call 999.

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Sources

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