Exaggerated Physiologic Speckled Mottling of the Limbs

Various forms of physiologic vascular mottling of the skin¹ are recognized that differ from mottling of the limbs seen as a reaction to cold.² Physiologic mottling is thought to be due to increased vascular tone in arteriolar territories³ and is not usually severe enough to warrant referral to a dermatologist. We report herein a case of physiologic mottling severe enough to prompt the patient to seek medical advice.

Report of a Case  A 20-year-old woman had a four-year history of asymptomatic white macules on the limbs. The macules were most florid during the winter, but were present during the summer months as well, when they caused considerable cosmetic disability because they were less easily covered by clothing. Only immersion in warm water caused the macules to disappear completely. Onset was not obviously related to the menarche, which started when the patient was 13 years old, or to the taking of a combined oral contraceptive