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This term means “marbled skin” and is intended to describe the appearance of the skin in which the terminal vessels are so superficial and dilated that they are constantly visible in patterns that vaguely suggest veined marble. This condition is physiologic in the newborn and represents a vasomotor response to lowering of the environmental temperature. Persistent cutis marmorata is seen in Down syndrome and in trisomy 18.

This condition is present at birth and consists of accentuated vascular markings (cutis marmorata), along with areas of telangiectasia, ulceration, and atrophy. The lesions may be localized or generalized. A small minority of children with this condition have other abnormalities, among them are mental retardation and hemiatrophy or hemihypertrophy. The mottling resolves gradually with age in most patients.

Livedo means a slate-gray blueness. Reticularis means “like a net.” The term describes a network of gray-blueness that is generally seen on the lower extremities. The idiopathic form of this disorder, most common in young women, carries a good prognosis. However, livedo reticularis is also seen in association with polyarteritis nodosa, systemic lupus erythematosus, and cryoglobulinemia.

This rare vascular disorder is most commonly seen in girls and tends to favor the extremities. The patient shown here has numerous areas of vascular ectasia in a gyrate pattern. As one observes the condition over long periods of time, one sees resolution of old lesions and development of new ones at the periphery. Though the condition tends to abate, it never quite leaves.

The salmon patch is by far the most common vascular lesion in the newborn. This midline or symmetrical pink macular lesion is most commonly seen on the eyelids, the nape of the neck, and the glabella. The last two are commonly described as “stork bite” and “angel's kiss,” respectively. The glabellar lesion in Fig. 20-5 can be expected to resolve spontaneously, as do lesions on the eyelids. Rarely, a salmon patch on the neck may persist into adult life.

This unilateral vascular malformation has a markedly different histology, significance, and natural history from that of the salmon patch. The port-wine stain is made up of capillary ectasias that may be present throughout the dermis and that gradually increase with age. The color changes from pink to purple as the patient grows, and the lesions may become nodular during adult life. Because port-wine stains show no tendency to involute, they may represent a significant, lifelong cosmetic problem.

Figure 20–6

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