Derm Dx: An infant with mottled skin - Clinical Advisor

Derm Dx: An infant with mottled skin

Slideshow

  • Cutis Marmorata 1_1112 Derm Dx

  • Cutis Marmorata 2_1112 DermDx

Parents bring their 3-week-old daughter to the dermatology clinic concerned about recurrent mottling of her skin when it’s exposed to cold. The skin changes improve when the skin is warmed, they explain. What’s your diagnosis?

Cutis marmorata is an asymptomatic condition that presents as a transient reticulated bluish discoloration. It is caused by vasoconstriction of cutaneous blood vessels in response to a decrease in temperature, and occurs in almost all newborns and infants. The condition...

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Cutis marmorata is an asymptomatic condition that presents as a transient reticulated bluish discoloration. It is caused by vasoconstriction of cutaneous blood vessels in response to a decrease in temperature, and occurs in almost all newborns and infants.

The condition may last from minutes to hours, but the discoloration disappears completely upon rewarming. The legs are the most prominently affected body part. There is no associated itching, burning or pain. 

Although cutis marmorata usually resolves by age 6 to 12 months, it may occasionally affect children and adolescent girls.1, 2

Similarly, livedo racemosa is characterized by a reticulate bluish discoloration that is most prominent on the lower extremities. But the lesions of livedo racemosa are fixed in contrast to the transient lesions associated with cutis marmorata. Cutis marmorata is a physiologic response to decreased temperature, whereas livedo racemosa may be associated with an underlying pathologic state such as vasculitis, hypercoagulability, medication reactions, neurologic disorders and embolic events.1,2

Erythema ab igne is reticulated erythema or reticulated hyperpigmentation resulting from chronic exposure to excessive heat. The condition is frequently seen on the lumbar backs of patients who chronically use heating pads to treat lower back pain. Initially, a reticulated erythema appears, which subsequently fades into a brownish-greyish reticulated hyperpigmentation. The lesions resolve with time if heat exposure is avoided.2

Pernio — also called chilblains — refers to erythema and edema associated with exposure to a cold and damp environment. Pernio most frequently affects the hands, feet and ears. Acrocyanosis affects young women and is characterized by a persistent bluish discoloration of the entire hand or foot. It is worsened by exposure to cold temperatures. 2 

Diagnosis & Treatment

Cutis marmorata diagnosis is based on the clinical appearance of reticulated bluish discoloration in an infant or child that occurs upon exposure to cold, but resolves upon rewarming. The condition is considered a normal physiological response to cold and no treatment is necessary. Most cases resolved by 1 year of age. 2  

If the lesions are fixed or develop purpura or necrosis, a diagnosis of livedo racemosa should be considered. 

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.

References

  1. Bolognia J, Jorizzo JL, Rapini RP. Chapter 106: Other Vascular Disorders.” Dermatology. St. Louis, Mo.: Mosby/Elsevier, 2008.
  2. James WD, Berger TG, Elston DM et al. Andrews’ Diseases of the Skin: Clinical Dermatology. Chapters 3 and 35. Philadelphia: Saunder Elsevier, 2006.
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