Cutis Marmorata
Cutis Marmorata
Cutis marmorata is a common physiologic response in newborns characterized by a reticular, marble-like pattern of skin mottling. It represents a vasomotor response to cold exposure and typically resolves with warming.
Key Points
- Prevalence: Extremely common in newborns (>50%)
- Peak Occurrence: First few weeks of life
- Trigger: Cold exposure
- Resolution: Usually improves with warming
- Pattern: Reticular, fishnet-like appearance
Primary Characteristics
- Morphology:
- Reticulated, marble-like pattern
- Purple to red discoloration
- Symmetrical distribution
- Network-like vascular pattern
- Blanches with pressure
- Distribution:
- Trunk (most common)
- Extremities
- Typically symmetrical
- Can be generalized
- More prominent on extensor surfaces
Natural History
- Temporal Pattern:
- Appears within minutes of cold exposure
- Resolves with warming (15-30 minutes)
- More prominent in morning
- Decreases with activity
- Age-Related Changes:
- Most prominent in newborn period
- Gradually decreases over first months
- May persist up to 6-12 months
- Can occasionally persist into early childhood
Physiological Cutis Marmorata
- Characteristics:
- Temperature-dependent
- Symmetric pattern
- Complete resolution with warming
- No associated symptoms
- Normal growth and development
- Expected Course:
- Self-limiting
- Improves with age
- No long-term sequelae
- No treatment needed
Pathological Variants
- Cutis Marmorata Telangiectatica Congenita:
- Present at birth
- Persistent pattern
- Does not resolve with warming
- Often unilateral or segmental
- Associated with other anomalies
- Red Flags:
- Persistent beyond expected age
- Asymmetric distribution
- Associated developmental delays
- Presence of atrophy or ulceration
- Concurrent congenital anomalies
Primary Associations
- Normal Variants:
- Acrocyanosis
- Harlequin color change
- Mongolian spots
- Physiologic jaundice
- Pathologic Associations:
- Down syndrome
- Trisomy 18
- Cornelia de Lange syndrome
- Hypothyroidism
- Neonatal lupus
Systemic Considerations
- Cardiovascular:
- Heart defects
- Peripheral vascular anomalies
- Vasomotor instability
- Neurologic:
- Seizure disorders
- Developmental delay
- Autonomic dysfunction
Diagnostic Approach
- History Taking:
- Age of onset
- Relation to temperature
- Pattern of occurrence
- Family history
- Associated symptoms
- Physical Examination:
- Distribution pattern
- Color changes
- Response to warming
- Associated findings
- Growth parameters
Differential Diagnosis
- Vascular:
- Livedo reticularis
- Livedo racemosa
- Port wine stains
- Capillary malformations
- Systemic:
- Antiphospholipid syndrome
- Vasculitis
- Cold agglutinin disease
- Neonatal lupus
Treatment Approach
- General Measures:
- Maintain optimal temperature
- Appropriate clothing
- Avoid excessive cold exposure
- Regular monitoring
- Parent Education:
- Natural history explanation
- Expected duration
- Warning signs
- Temperature regulation tips
Monitoring
- Regular Assessment:
- Pattern changes
- Development monitoring
- Associated features
- Growth parameters
- Indications for Referral:
- Persistent beyond 6-12 months
- Associated anomalies
- Developmental concerns
- Asymmetric or unusual patterns
Important Considerations
- Documentation Tips:
- Photograph distribution pattern
- Note temperature dependence
- Track resolution time
- Record associated features
- Prevention Strategies:
- Maintain room temperature 72-75°F
- Layer appropriate clothing
- Avoid direct cold exposure
- Regular skin assessments
Special Scenarios
- Premature Infants:
- More pronounced patterns
- Longer duration
- Closer monitoring needed
- Temperature regulation crucial
- Follow-up Care:
- Regular well-child visits
- Developmental screening
- Parent reassurance
- Documentation of resolution
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
