Mottled skin, or livedo reticularis from its scientific name, is characterized by the appearance of purplish, red or pale spots on the skin. Benign forms, often related to cold exposure, should be differentiated from pathological forms that may be one of the clinical signs of an underlying disease.

What is it ?

Marbling are purplish, red or pale areas that can appear on the skin, locally or all over the body. They form a sort of more or less regular mesh on the skin, giving it this marble appearance.

The scientific name for mottled skin is livedo reticularis, from the Latin livedus meaning “bluish”.

Risk factors

• cold: the so-called physiological livedo is generally triggered by cold, and disappears on warming;
• age: newborns often have mottled skin during the first weeks of life, because their skin, which is still immature, does not know how to regulate body temperature well. Thus, the mottles tend to increase after a bath or a change, when the baby is exposed to the cold. This benign phenomenon ends up disappearing over the weeks, when the baby’s organism matures;
• the female sex: women are more prone than men to physiological livedo.

The mottled skin is generally due to a slowdown in the circulation at the level of the skin microvasculature. The mottles appearing on the surface of the skin then correspond to deoxygenation of the blood flow and to blood stasis in the venules.

Different mechanisms can be at the origin of this phenomenon, and it is important to differentiate physiological forms from pathological ones.

Physiological livedo

Le livedo reticularis physiological, also called cutis marmorata, is triggered by exposure to cold and disappears entirely with warming. It is usually located in the lower limbs, and more often affects newborns and women.

The secondary livedo

In some cases, marbled skin is one of the clinical signs, among others, of an underlying disease. The marbles then form a thick and irregular mesh network, permanent, sometimes necrotic, which can reach not only the limbs but also the trunk. Among the pathologies that can be the cause of a livedo, we mention in particular:

• antiphospholipid antibody syndrome;
• Sneddon syndrome, a rare disease affecting mainly women between the ages of 20 and 40. The livedo is then often localized at the level of the trunk and associated with ischemic cerebrovascular events;
• cryoglobulinemia, which may itself be associated with hepatitis C, an autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome), HIV, etc;
• systemic lupus erythematosus;
• etc.

Le marbled skin Telangiectatica congenita (CMTC)

It is a rare congenital vascular disease manifested by a persistent form of cutis marmorata with bluish to dark purple mottling, either localized or generalized. In the majority of cases, the disorders appear from birth.

Other causes of livedo 

• taking certain medications, such as amantadine (used in particular as a prophylaxis against influenza), may lead to the appearance of livedo which will disappear when treatment is stopped;
• septic shock causing circulatory distress;
• sometimes no cause is found. We then speak of primary livedo or idiopathic livedo. The evolution of these forms must be monitored.

Marbled skin does not in itself present any risk of complications. In its physiological form, it disappears when the body warms up. In secondary forms, the complications to fear are those of the underlying disease. 

In the majority of cases, livedo is physiological and does not require treatment. Its prevention is based on avoiding the cold.

For the forms of secondary livedo, it is advisable to carry out a clinical examination and other additional examinations according to the age of the patient and the associated signs, in order to detect the possible underlying pathological in question, and if necessary, the to treat.