A 32-year-old woman with a long history of Raynaud’s phenomenon presented for assessment of severe fatigue and a mottled, purplish discolouration of the skin of her lower extremities. The patient has a diagnosis of chronic idiopathic dysautonomia.
The appearance of the patient’s legs during assessment suggests livedo reticularis (figure A). However, her legs do not show marked patterns of discolouration after waking up in the morning (figure B). The patient also noted that the mottled skin would go away if she were outside in warm weather or after a hot shower.
What is the most likely cause of her mottled skin discolouration?
