
Thank you Dr. Thomas!
I just ordered the new edition of The Lupus Encyclopedia.
Thanks for all you do for the Lupus community!
Lupus is a complex autoimmune disease that affects various parts of the body, including the skin. Among the skin manifestations commonly associated with lupus is “mottled skin”. This is a condition where the skin appears patchy, discolored, and uneven. In this article, we will explore the phenomenon of lupus-mottled skin, its symptoms, potential causes, and effective management strategies.
Lupus mottled skin, also known as livedo reticularis, presents a skin condition characterized by a lacy, net-like pattern of reddish or bluish discoloration on the skin’s surface. These patches often appear in a symmetrical pattern on the arms, legs, and torso. Livedo reticularis most commonly affects the legs. The constriction of blood vessels near the skin’s surface causes discoloration, leading to reduced blood flow in those areas.
Lupus can affect the blood vessels causing a reduction in blood flow and the condition is called livedo reticularis. Livedo reticularis is a rash caused by decreased blood flow in small blood vessels beneath the skin. It forms net-like areas of reddish or purplish discoloration, especially on the arms and legs. There’s usually no permanent scarring and it rarely causes significant problems.
It can be more noticeable during periods of stress and cold. People with livedo reticularis sometimes (but not always) are positive for antiphospholipid antibodies. People with antiphospholipid syndrome can develop livedo reticularis, as well as a more extreme example of livedo called livedo racemosa. If livedo reticularis occurs in someone with a stroke, it is called Sneddon syndrome. Sneddon syndrome is sometimes, but not always, due to antiphospholipid antibodies. (This section on livedo reticularis comes from The Lupus Encyclopedia, 2nd edition, chapter 8). The photo page of this website contains a photo of livedo reticularis on a lupus patient.
If lupus causes actual inflammation of the blood vessels, it is called vasculitis. This inflammation can cause blood vessels to constrict and reduce blood flow, resulting in the mottled appearance of the skin.
Some individuals with lupus may also experience a condition called Raynaud’s phenomenon. This is where blood vessels in the extremities narrow in response to cold temperatures, leading to a similar mottled appearance.
Certain medications can cause mottled skin. Beta-blockers, amantadine, vasoconstrictors, and nonsteroidal anti-inflammatory drugs, and minocycline can cause livedo reticularis or mottled skin.
This section comes from The Lupus Encyclopedia, 2nd edition, chapter 8: Livedoid vasculopathy is a rare cause of skin ulcers. Livedoid vasculopathy starts with a rash on the arms or legs that can look like livedo reticularis, hence the term “livedoid.” It is caused by an abnormality of the small arteries (vasculopathy) within the skin, causing reduced skin blood flow and painful ulcers, especially on the feet.
While mottled skin itself may not be a cause for immediate concern, it could be a sign of underlying vascular issues or complications. If mottled skin is accompanied by other symptoms, such as pain, numbness, or changes in skin texture, seeking prompt medical evaluation is crucial.
Individuals with lupus commonly associate lupus-mottled skin, or livedo reticularis, with a lacy pattern of reddish or bluish discoloration on the skin’s surface. It is important to understand that mottled skin may be a symptom of underlying vascular changes or medication-related side effects. While usually harmless, seeking medical attention and managing underlying conditions is essential for maintaining skin health and overall well-being. Working closely with healthcare providers can help individuals with lupus effectively manage mottled skin and other skin manifestations associated with this complex autoimmune disease.
Thank you Dr. Thomas!
I just ordered the new edition of The Lupus Encyclopedia.
Thanks for all you do for the Lupus community!
This is an article I needed to read four years ago. I discovered molted skin in a small area on the inside of my right knee, this was immediately after I had a stroke of unknown cause at age 44. I though maybe it was from hospital staff transferring me to the gurney after an MRI. I spent three years trying to figure out what the mottled skin was, which spread up and down both of my legs Ended up doing my own research and a follow up with Rhumatology to learn that it was Livedo R. Apparently I test negative for other autoimmune diagnosis except Lupus. Which is a relief at this point.
Christine: Thank you for sharing your story. Hopefully others will learn from it. Did your doctors end up calling it Sneddon syndrome? Sneddon syndrome is livedo along with stroke in the same patient.
Donald Thomas MD
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