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Jan 07, 2022
6 min read

Mottled skin: causes, symptoms, and when to be concerned

Cold weather or underlying health conditions can cause a net-like pattern of reddish or purplish splotches called mottled skin. It’s typically harmless if it appears when you’re in a cold environment but may be a sign of something else.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

The skin is our largest organ, and yet, it tends to go unnoticed unless something looks out of the ordinary. 

Unexpected bumps, splotches, or changes in skin color may send you running to a dermatologist. Talking to a healthcare professional is never a bad idea, but skin changes such as mottled skin can take you down a scary Google rabbit hole should you look for your answers there. 

If you notice that you have mottled skin, here’s what you need to know.

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Signs of mottled skin

Mottled skin has irregular coloring, which can be reddish or purple. This discoloration is generally patchy and uneven and can look like spots or streaks. The spots can also connect, creating a net-like pattern. 

Healthcare professionals often refer to mottled skin as livedo reticularis.

The most significant sign is a visual change in your skin’s appearance, but some people can experience other symptoms simultaneously. Individuals with mottled skin may also experience skin ulcers or nodules (like small, marble-like structures under their skin). 

The discoloration of mottled skin often goes away on its own (more on that later) but sometimes, the underlying cause may require medical treatment.

Causes of mottled skin

Mottled skin is often harmless. Anything that affects blood flow to the skin can cause discoloration. In rare cases, mottling of the skin can signify something more serious, especially when it appears with other symptoms.

Cold

Some people experience blotchy, discolored skin due to cold weather. That’s because chilly temperatures tell your body to keep your blood around your vital organs and less around your limbs, where it could continue to lose more heat. This causes your blood vessels to constrict, limiting circulation to the skin and resulting in the mottled skin pattern you see. Temporarily mottled skin caused by a cold environment is harmless and not a cause for concern.

When mottled skin appears in your hands and fingers in response to cold or stress, it’s often referred to as Raynaud’s phenomenon. Sometimes, this can be a sign of another underlying condition, like thyroid problems. 

Lupus

A butterfly-shaped rash on the face is the most common skin symptom of lupus, but this autoimmune disease can also cause mottled skin. Skin discoloration triggered by lupus happens when veins swell under the skin, making them more visible (Uva, 2012). Lupus can cause a range of other symptoms, many of which require regular monitoring and treatment. If you have mottled skin all the time that doesn’t go away in addition to any of the other symptoms associated with lupus, it may be a good idea to have a check-up. 

Other symptoms of lupus include: 

  • Tiredness
  • Joint pain or stiffness or swelling
  • Skin lesions that appear or worsen with sun exposure
  • Fingers and toes that turn white or blue when exposed to cold or during stressful periods
  • Fever

Shock

Shock is an extreme, life-threatening drop in blood pressure that can be caused by blood loss, injury, poison, or burns. When your blood isn’t flowing properly, one of the first signs can be mottled skin can occur. 

And while mottled skin can appear with shock, the other symptoms of shock are far more prominent (dizziness, difficulty breathing, loss of consciousness), so if you’re googling “Why do I have mottled skin,” it’s safe to bet that you are not currently experiencing shock. 

If you do see someone who is experiencing symptoms of shock, however, it’s important to seek emergency medical attention (Koya, 2021). Signs of shock include:

  • Mottled, pale, or cold skin
  • Low blood pressure
  • Fainting
  • Fast heart rate
  • Nausea or vomiting
  • Dizziness
  • Trouble breathing

If you are experiencing any of these symptoms, seek medical attention right away.

Blood vessel (vascular) conditions

If there is a problem with a person’s blood vessels, it can affect their body’s ability to carry and distribute their blood. When blood isn’t reaching your skin properly, it can cause mottled skin. 

Atherosclerosis, a condition characterized by a buildup of plaque on walls of blood vessels, may lead to skin discoloration. Other examples include blood clots and vasculitis (inflammation of the blood vessels).

Medication

Some drugs are known to cause mottled skin. Your skin may not appear red or purple right away, and could arise a month or more after starting the medication. Examples of drugs that may cause mottled skin include: 

  • Amantadine is a medication often used to treat Parkinson’s disease. It can cause mottled skin that appears mostly in the legs and more commonly occurs in women using the drug (Quaresma, 2015). 
  • Catecholamines are naturally-occurring molecules in our body but they are sometimes administered by healthcare professionals as treatments, especially in emergencies. These medications can cause mottled skin 
  • Gemcitabine (brand name Gemzar) is a medication used to treat different forms of cancer. In some cases, gemcitabine can cause mottled skin, but this may be a sign of a different drug complication. If you are currently receiving treatment with gemcitabine and you notice mottled skin, it’s important to speak with your treating provider (Zemtsov, 2012). 
  • Minocycline (brand name Minocin) is a type of antibiotic often used to treat acne. In rare cases, it can cause mottled skin, which may be associated with lupus (which we mentioned above) (Schlienger, 2000). If you are taking minocycline and you notice mottled skin, consult with a healthcare provider. 

These are just a few of the medications that can cause mottled skin. If you notice that a medication you’re taking might be causing skin changes, speak with your healthcare provider or pharmacist.

Mottled skin in children and babies

Mottled skin can sometimes show up in newborns and babies. Often, this results from a cold environment and should disappear if you add another layer of clothing and keep them warm. 

Rarely, thyroid problems can also cause mottled skin in newborn babies. If discoloration is due to thyroid problems, the baby may also have jaundice (yellowing of the skin or eyes) or face puffiness. Roughly 1 in 4,000 babies are born with hypothyroidism, a condition treatable with daily medication (Iyer, 2020; Saran, 2019).

Risk factors

Risk factors for developing mottled skin include a family history of the condition or a history of any of the underlying conditions that can contribute to it. The best way to manage any risk factors is to work with a healthcare professional to manage your underlying condition.

You’re also more likely to experience mottled skin if you take a medication known to cause such a skin reaction.

Diagnosis

On the plus side, mottled skin is very easy to diagnose. 

A healthcare provider can immediately spot mottled skin. They’ll then test for any other causes of your skin discoloration. Depending on your medical history, they may run specialized tests to see if you have a disease known to cause mottled skin. Since medication can also cause skin reactions, they’ll likely ask about any prescriptions you’re taking.

Treatment options

Warming up your skin with a warm bath, sweater, or blanket will quickly treat mottled skin caused by cold.

If you have an underlying condition that causes it, work with a healthcare professional to treat it. Since mottled skin is a symptom of some health issues, getting that under control may resolve skin discoloration.

If your medication is causing mottled skin, talk to a healthcare provider about alternative treatments. They may be able to suggest a different prescription or lower the dosage of what you’re currently taking.

Prevention

You can’t control what health conditions you inherit or how you react to certain medications. That limits how much you can prevent mottled skin from happening. 

The strategies within your control include:

  • Keeping skin warm, especially in cold environments
  • Avoiding smoking, which can affect your circulation
  • Managing cholesterol levels
  • Keeping up lifestyle changes that prevent vascular diseases

When to see a doctor

Shock requires immediate medical attention. If you have symptoms of shock, get help right away.

If you have symptoms of lupus or a vascular condition along with mottled skin, see a healthcare provider. You may need to work with them long-term to manage your condition.

Also, it’s a good idea to speak with a healthcare professional if your mottled skin is new and has only appeared since starting a new medication. They can assess whether the skin change is a side effect of the prescription and work with you to prevent it.

References

  1. Iyer, P., Chen, H., & Mick, G. (2021). Congenital Hypothyroidism. Thyroid and parathyroid disorders in children: A practical handbook. essay, CRC Press. Retrieved from https://www.taylorfrancis.com/chapters/edit/10.1201/9780367419875-3/congenital-hypothyroidism-gail-mick 
  2. Koya, H. H., & Paul, Manju. (2021). Shock. [Updated July 26, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK531492/ 
  3. Quaresma, M. V., Gomes, A. C., Serruya, A., Vendramini, D. L., Braga, L., & Buçard, A. M. (2015). Amantadine-induced livedo reticularis–Case report. Anais Brasileiros de Dermatologia, 90(5), 745–747. Doi: 10.1590/abd1806-4841.20153394. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631243/
  4. Saran, S. (2019). Congenital Hypothyroidism, Thyroid Disorders, Poondy Gopalratnam Raman, IntechOpen. doi: 10.5772/intechopen.81129. Retrieved from https://www.intechopen.com/chapters/63959 
  5. Schlienger, R. G., Bircher, A. J., & Meier, C. R. (2000). Minocycline-induced lupus. A systematic review. Dermatology (Basel, Switzerland), 200(3), 223–231. Doi.org/10.1159/000018387. Retrieved from https://pubmed.ncbi.nlm.nih.gov/10828631/
  6. Uva, L., Miguel, D., Pinheiro, C., Freitas, J. P., Marques Gomes, M., & Filipe, P. (2012). Cutaneous manifestations of systemic lupus erythematosus. Autoimmune Diseases, 834291. doi: 10.1155/2012/834291. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410306/ 
  7. Zemtsov, A., Omueti-Ayoade, K., Zemtsov, R., & Yang, M. (2012). Livedo reticularis as an initial clinical manifestation of gemcitabine-induced hemolytic uremic syndrome. The Journal of Dermatology, 39(5), 487–489. Doi: 10.1111/j.1346-8138.2011.01353.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21906135/