Lupus Mottled Skin and the Symptoms

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.

What is Lupus Mottled Skin?

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.

Symptoms of Lupus Mottled Skin

1. Lacy Pattern: The defining characteristic of mottled skin is the intricate, lace-like pattern on the skin. It is more noticeable in colder temperatures.
2. Color Changes: The patches can appear reddish or bluish, depending on the temperature and underlying cause.
3. Temperature Sensitivity: The discoloration may become more pronounced in response to temperature changes, such as exposure to cold or hot weather.

Causes of Lupus Mottled Skin

Vascular Changes

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.

Vasculitis

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.

Raynaud’s Phenomenon

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.

Medications

Certain medications can cause mottled skin. Beta-blockers, amantadine, vasoconstrictors, and nonsteroidal anti-inflammatory drugs, and minocycline can cause livedo reticularis or mottled skin.

Livedoid Vasculopathy

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.

Management and Treatment

1. Lifestyle Modifications: Avoiding extreme temperatures and protecting the skin from cold or harsh weather can help reduce the severity of mottled skin patches.
2. Medication Adjustments: If lupus medications are causing mottled skin, you should consider working with a healthcare provider. They may recommend adjusting the dosage or switching to alternative medications. However, livedo reticularis is rarely dangerous. It is more of a cosmetic concern for most people.
3. Blood thinners: If antiphospholipid antibodies cause the livedo reticularis, then the health care provider may prescribe a blood thinner, such as aspirin. If these antibodies are causing more significant problems (such as blood clots, strokes, and heart attacks), then stronger blood thinners such as warfarin may be prescribed
4. Drugs that calm down the immune system. If lupus vasculitis causes the livedo reticularis, then your healthcare provider may prescribe drugs that calm down the immune system. For mild cases, hydroxychloroquine usually suffices. For more severe cases, the healthcare provider may prescribe immunosuppressants, such as steroids, methotrexate, belimumab [Benlysta], or anifrolumab [Saphnelo].

When to Seek Medical Attention

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.

Donald Thomas, MD edited and contributed to this post