Cutis Marmorata

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Basics ⬇

Cutis marmorata is a physiologic response of the dermal capillaries to cooler ambient temperatures that is commonly seen in newborns.

Pathogenesis ⬆ ⬇

Cool ambient temperatures cause vasodilatation of capillaries.

Clinical Manifestations ⬆ ⬇

Symmetric, blanchable, reticulated deep red to violaceous patches usually located on the extremities; less often on the trunk (Fig. 2.1).
Lesions typically resolve with rewarming.
Cutis marmorata may persist for several weeks to months but usually completely resolves with no sequelae.
In patients with Down syndrome or hypothyroidism, cutis marmorata may persist for a longer time.

Diagnosis ⬆

Diagnosis is based on clinical recognition and evidence of resolution with rewarming.

Helpful Hints

If diagnosis is in doubt, attempt to rewarm patient by swaddling to see if skin lesions disappear.
Physiologic cutis marmorata is blanchable and improves with warming.

Differential Diagnosis

Cutis Marmorata Telangiectatica Congenita (CMTC)

Persistent deep red or violaceous reticulated patches on an extremity that does not resolve with rewarming and does not blanch.
CMTC can be seen in association with several genetic syndromes including Adams-Oliver syndrome or can be associated with underlying hypoplasia of the affected extremity (Fig. 2.2).

Reticulated Port-Wine Stain

Will not disappear with rewarming.
Progressively darkens over time.

Management

The most important first step in management is to distinguish physiologic cutis marmorata from CMTC or a vascular malformation.
Physiologic cutis marmorata is a benign condition of no medical significance and will resolve spontaneously. Parents can be reassured.
To prevent lesions, parents should keep infants warm.