Cutis marmorata or mottling is a lacelike (reticulated), mottled, blanchable, violaceous pattern of erythema that appears over the extremities and trunk of neonates when exposed to a temperature decrease. Exposure to the cold may also induce more vasocontstriction in the acral rather than central areas of the body leading to a deep violaceous to blue coloration of the hands, feet and lips termed acrocyanosis. This occurs more often in the premature infant. This transient condition improves with rewarming and the tendency to occur decreases with age. There is no pathologic significance.

Differential diagnosis

Something more extensive is called cutis marmorata telangiectasia congenita may mimic mottling, but the color change will not disappear with rewarming. Another disease in the differential includes livedo retiularis with collagen vascular diseases such as neonatal lupus erythematosus which persists despite rewarming as well.

Pathophysiology

Immaturity of the autonomic control of the skin vascular plexus leading to the constriction of capillaries and venules is hypothesized as the reason for the mottling with constriction of the deep plexus and opening of the superficial plexus.