What does mottled skin mean near the end of life?

What does mottling look like?

The skin takes on a patchy, marbled look, with uneven areas of purple, blue, gray or pale skin. The Hospice Foundation of America lists the knees, feet, buttocks, ears and hands as the places it is most often seen. The skin there usually feels cool to the touch. The nails and lips may look bluish too.

Nurses often notice it first on the feet and knees, and it can spread up the legs. On darker skin the color change can be harder to see, and the skin may look grayer or darker than usual rather than purple. If you are not sure what you are seeing, the nurse can look with you.

Why does it happen?

As the body slows down near the end of life, the heart pumps less strongly and blood pressure usually goes down. Less blood reaches the skin farthest from the heart, so the hands, feet and knees cool first and change color. It is part of the body shutting down. Nothing the family did caused it, and nothing could have prevented it.

How close is death when mottling appears?

The Hospice Foundation of America describes these skin changes as often a sign that death will occur within days or hours. In a study of people with advanced cancer in palliative care units, bluish color in the hands and feet appeared mostly in the last 3 days of life.

The same study found that fewer than half of the patients had it even in their last 12 hours. So a person can be very close to death without mottling, and the nurse never goes by one sign alone. She looks at mottling together with breathing, response, urine and the other changes described in signs by timeframe.

Mottling can also come and go, and it can appear earlier during a serious infection or a sudden drop in blood pressure. If you see it, tell the nurse, who can tell you what she thinks it means for your family member.

What can you do for mottled skin?

Mottling itself needs no treatment. What helps is comfort.

• Keep the person warm, not hot. A light, soft blanket is enough if they seem cold.
• Do not use heating pads or electric blankets. The National Cancer Institute advises against them, and the Hospice Foundation of America notes that thin, fragile skin burns easily.
• Let them push the blanket away. The National Institute on Aging notes that someone who is too warm may keep trying to remove a blanket. A cool cloth on the forehead can help.
• Turn and reposition gently, the way the nurse or aide showed you. It eases stiffness and protects the skin. Ask the nurse how often to do it at this stage.
• Keep the skin clean and dry, and tell the nurse about any sore or open area.
• Stay close and keep talking. Most people can still hear after they can no longer speak. Hold a hand, tell them who is in the room and say what you want to say.
• Call family who want to be there, if the nurse thinks the time is short.

Is mottling painful?

Mottling is not thought to cause pain. Pain can still come from other things, such as stiff joints or pressure on the skin. Watch for signs of discomfort in someone who cannot speak: grimacing, moaning or groaning, stiffening when moved, clenched fists or teeth, calling out, or restlessness. Tell the nurse if you see them. The nurse can adjust comfort medicines, including forms that do not need swallowing.

Common questions

Related guides

This page is part of signs that death is near. The other pages in the series: signs by timeframe, transitioning and active dying, the death rattle, terminal agitation, how long someone can live after they stop eating and drinking and dreams and visions near death. After the death, see what to do when your loved one dies at home.