Actually, finding reticulated marble-like patterns on the limbs of children does not necessarily mean that the child has heart disease, because marble-like patterns can also be divided into physiological skin changes and pathological skin changes.
Ordinary parents just need to understand what is a normal situation and what is a situation that requires a doctor’s visit.
What is marble-like patterning?
Marble-like patterning typically refers to patterns on the skin that resemble marble, a phenomenon medically known as Cutis marmorata. Cutis marmorata manifests as purplish-red or light blue reticular patterns on the skin, similar to the texture of marble.
(Image source: consultant360)
Upon close examination of these blood vessels, one can even see a purplish-red or congested state, hence the dermatological community has named this phenomenon as “ livedo reticularis (LR)”.
The occurrence of livedo reticularis is mainly due to changes in blood flow in the skin’s microvascular system, with the aggregation of deoxygenated blood in some superficial venous plexuses, leading to the changes and distribution of livedo reticularis.
People with thinner skin can more easily reveal the changes in capillaries through the skin, so newborns, infants, and those with relatively thin skin are more likely to be observed with marble-like skin changes.
Why does marble-like skin occur?
There are many causes for marble-like skin, which can generally be divided into physiological or pathological categories. The common related diseases are as follows:
This is usually the most common physiological skin reaction to cold and is a temporary phenomenon. It usually occurs in the newborn period or infancy, especially noticeable when exposed to cold.
Because infants’ limbs usually do not show obvious striping reactions on the skin, when the limbs are cold, the skin will show temporary red-blue reticular patterns, mostly occurring on the lower limbs and trunk, and the patterns disappear spontaneously when the limbs are warm, generally without any symptoms.
This phenomenon can occur in 50% of normal children and adults, usually does not require treatment and will improve on its own with age.
Also known as congenital livedo reticularis, this is a congenital vascular malformation that appears at birth or shortly after birth.
A 4-month-old girl with congenital capillary telangiectasia reported by BMJ
This type of marble-like skin usually presents as persistent, relatively large purple or blue reticular patterns, mainly distributed on one side of the limb, and even when the external temperature rises or the skin is well-protected, the patterns are hard to fade.
The skin marble-like changes can persist for months or years, and about 20% of people may see the rash disappear with age, but more often, these vascular changes can persist for many years, even deepening, possibly accompanied by pain and bleeding.
Children with congenital capillary telangiectasia may sometimes have other congenital abnormal signs, such as limb asymmetry, patent ductus arteriosus, congenital glaucoma, port-wine stains, and other vascular malformations.
Therefore, if a child’s marble-like skin is limited to a single limb and does not fade after warming,it is best to ask a pediatrician to determine whether there is further examination of the child for signs of cyanosis, limb asymmetry, and other internal organs.
It may be caused by other diseases or medications, such as severe infections, respiratory/circulatory failure, early shock, etc.
Adults are more likely to develop this condition, and secondary marble-like skin in adults may be related to intravascular obstruction or vascular wall-related diseases.
The cause is unknown, mainly occurring in young and middle-aged women, the condition is often mild and harmless, and can be combined with physiological livedo reticularis. The rash often occurs in the 30s to 40s, starting after exposure to cold, lasting briefly, and then becoming persistent, with skin tingling and numbness.
Severe cases may develop ulcers, which heal slowly, and after healing, may leave white atrophic scars, usually also known as “livedo vasculopathy”, requiring further treatment.
The latter two types of marble-like skin changes are usually seen in adults and will not be detailed here.
What to do if a child has livedo reticularis-like changes?
From the introduction above, if you find that your child’s body has livedo reticularis-like changes,first try to keep the child warm and see if it can fade. If it obviously fades, then just keep the child warm and observe.
If the persistent rash does not fade, it is best to visit a dermatologist or pediatric vascular specialist for further examination of the child’s systemic vessels or heart,and if necessary, control the progression of symptoms through medication, laser treatment, or surgery.
Especially for children diagnosed with congenital capillary telangiectatic marble-like skin
(CMTC),regular monitoring and follow-up may be required to observe changes in symptoms and potential complications.
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