Persistent Cutis Marmorata in a 3-Month-Old Infant with History of In-Utero Opioid Exposure

Case at a Glance

A 3-month-old female infant presents with persistent cutis marmorata (mottled skin pattern) that has been present since birth. The infant has a history of in-utero opioid exposure due to maternal Suboxone treatment during pregnancy.

Patient's Story

The patient is a 3-month-old female who was born to a mother with opioid use disorder who was maintained on Suboxone (buprenorphine/naloxone) throughout pregnancy for addiction recovery. The infant has exhibited a distinctive mottled, lacy skin pattern (cutis marmorata) since birth. The mottling becomes more pronounced with cold exposure but remains visible even when the infant is warm. The family is concerned about the persistence of this skin pattern at 3 months of age.

Initial Assessment

The infant appears otherwise healthy with appropriate weight gain, normal feeding patterns, and achievement of developmental milestones. Physical examination reveals a reticular, lace-like skin pattern consistent with cutis marmorata. The pattern is more prominent with cold exposure but persists in neutral thermal conditions. No other concerning physical findings are noted.

The Diagnostic Journey

Initial hospital assessment attributed the prominent mottling to neonatal abstinence syndrome secondary to in-utero opioid exposure. However, given the persistence at 3 months of age, differential diagnosis includes physiologic livedo reticularis versus pathologic cutis marmorata telangiectatica congenita (CMTC). Clinical correlation and continued monitoring are warranted to distinguish between benign physiologic patterns and more concerning vascular malformations.

Final Diagnosis

Physiologic livedo reticularis (cutis marmorata) - likely benign variant that may have been accentuated by neonatal abstinence syndrome

Treatment Plan

Conservative management with continued observation. No specific treatment required for physiologic livedo reticularis. Parents educated about the benign nature of the condition and expected gradual improvement with age. Routine pediatric follow-up scheduled to monitor development and skin pattern evolution.

Outcome and Follow-up

Patient continues to thrive with normal growth and development. The cutis marmorata pattern is expected to gradually improve over the first year of life. Follow-up appointments will monitor for any changes in the skin pattern and ensure continued normal development. Parents have been reassured about the likely benign nature of the condition while maintaining appropriate medical surveillance.