This article has been medically reviewed by Dr. Martin Duggan in 2021
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Mottled skin can be a source of confusion for families caring for a loved one at the end of life. However, it’s common to see skin mottling in our loved ones as death approaches. In this article, we will go over what mottled skin is, why it happens, and other physical changes that occur a the end of life.
Before we go any further, we should be clear. This article is intended for those who are providing care for a person at the end of life. Seeing skin mottling in an otherwise healthy person is NOT normal. While there are benign causes of skin mottling in healthy adults, marbling of the skin can also be a sign of dangerously low blood pressure or shock. Because it can be a sign of a life-threatening illness, unless someone is expected to die, skin mottling needs to be evaluated by a doctor immediately.
Many of the common changes we can expect to see while we provide end-of-life care would never be expected or normal in someone who isn’t dying.
What is mottled skin?
Mottled skin is generally characterized by a purple marbling of the skin. It may look blotchy and usually starts on the feet and travels up the legs.
It happens on the skin’s surface because of the blood vessels below it. Due to circulation issues, these blood vessels appear and discolor the skin with this netlike pattern.
What does mottled skin look like?
It’s often described as marbling, blotchy, netlike, webby, or stained. Characteristically, the skin may appear pale with streaks of purple or red where blood vessels in the skin have a prominent appearance.
Does mottled skin hurt?
Mottled skin can look alarming, but it’s not always painful. However, a person with skin mottling might feel cold, especially in their arms and legs. When you see mottling, a warm blanket or two might be helpful. Doctors generally recommend against using heated blankets for people who might have a difficult time communicating pain or discomfort. A heated blanket, if left in one place for too long, can cause serious burns in someone who is at the end of life.
Mottled skin in seniors may go away on its own. However, it may also be a sign of imminent death. If the patient is near an expected death, a doctor may recommend nothing more than some extra blankets. If the person is not expected to die very soon, then caregivers should reach out to their doctor right away.
What causes mottled skin?
Mottled skin can be caused by a variety of issues that impact circulation and heart strength in people at the end of life. We will list a few of the more common causes below:
- End of life
- Poor circulation
- Cold environment
- Side effect of medications (especially for Parkinson’s)
- Side effect of health conditions such as vascular disease, lupus, RA, antiphospholipid syndrome, hypothyroidism, pancreatitis
- Shock from blood loss, infections, poisons, or burns (this is a medical emergency)
If this list appears to be scary, we should remember what we have discussed above. Mottled skin is one of many findings that we may encounter at the end of life, that would never be expected or normal in someone who isn’t dying. As we die, our organ systems respond to our impending death by slowing down and eventually stopping. Mottled skin is a sign that our circulatory system – made up of our hearts and our blood vessels – is slowing down.
Do I need to call the doctor when I see mottled skin at the end of life?
It is never a bad idea to call your doctor. Doctors expect you to call them and ask questions. You should never hesitate to call the doctor, even at the end of life. Even when it’s late at night, or when the doctor is a specialist, if you have a question about end-of-life care, then doctors will welcome your phone call. Doctors in modern times, do not expect people at the end of life to suffer. If you are concerned that your loved one may be suffering or if you need reassurance about something you are unsure about, then you should call the doctor right away.
While we here at mycaringplan.com are dedicated to providing supplemental resources about common health questions that arise as we care for the elderly or for someone who is dying, we will always encourage our readers to reach out to their physician with questions.
How can I treat mottled skin?
Once we have spoken with the doctor, there will likely be steps that we can take to ensure that our loved one is comfortable. This is especially the case when our loved ones are unable to communicate at the end of life. In those instances, skin mottling may be one of many signs that can indicate that the person for whom we are caring is cold. Often the best treatment will involve no more than adding a few extra blankets. However, only a health care professional is qualified to determine if nothing further needs to be done. That is why it is so important to reach out to the doctor.
How can I prevent mottled skin?
The best way to prevent skin mottling, is to keep our loved ones warm and comfortable. Once again, experts strongly advise against the use of heating blankets. But keeping someone comfortable and warm with an extra blanket or two is something that is encouraged.
Mottled skin as a sign of nearness to death.
Mottled skin in seniors may also be a sign of end of life. Researchers think that it happens near the end of life because the heart is unable to circulate blood properly. If you notice it in a senior who is terminally ill, it may be an important sign that death is approaching.
After developing mottled skin, how long until death?
This is a good question that is best answered by the doctors or nurses familiar with your loved one. This is because the answer will depend on how far along your loved one is in the dying process.
Does mottled skin always occur before death?
Not all seniors will experience mottled skin before death, though it is fairly common. As we noted above, skin mottling happens becuase of changes to our circulation. Our circulatory system slows and ultimately stops at the end of life, so changes like skin mottling are common. However, not all seniors will experience it before dying.
What are some other signs of end of life?
You may notice certain signs of end of life. A person near death will experience changes in their physical and emotional well-being. Some signs include:
- Physical changes including loss of appetite, weight loss, more sleep than usual, incontinence, cold hands or feet, drops in body temperature, and drops in blood pressure.
- Breathing changes, including periods of slow deep breathing, shallow rapid breathing, coughing, or noisy breathing.
- Neurological changes such as withdrawal from loved ones, unresponsive periods, or terminal restlessness.
Mottled skin can arise from a variety of different conditions. At the end of life, skin mottling may not require anything beyond a few extra blankets, but it is still important to let your doctor know what is happening and to ask for their input.
Mottled skin is just one aspect of care provision at the end of life. If you’re interested in learning more about providing excellent care at the end of life, you can get more information on MyCaringPlan.
- Palliative Care, Signs and Symptoms of Approaching Death, https://www.saintlukeskc.org/health-library/hospice-and-palliative-care-signs-and-symptoms-approaching-death
- What’s Causing My Mottled Skin?, Healthline, https://www.healthline.com/health/mottled-skin
- What causes livedo reticularis? When should I see a doctor?, Mayo Clinic, https://www.mayoclinic.org/livedo-reticularis/expert-answers/faq-20057864
- Signs of Approaching Death, Hospice Foundation of America, https://hospicefoundation.org/Hospice-Care/Signs-of-Approaching-Death