Why is a dying person's skin becoming blotchy or purple?
Blotchy or purple skin near death often happens because circulation is slowing and blood is not reaching the skin evenly.
Blotchy or purple skin near death often happens because circulation is slowing and blood is not reaching the skin evenly. This is sometimes called mottling.
Mottled skin can be a sign that death may be close, especially when it appears with cool hands and feet, very little urine, long sleep, poor swallowing, and changed breathing.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
What mottling can look like
The skin may look patchy, blotchy, blue, purple, grey or dusky. It may start on the feet, toes, hands or knees. It can spread upward as circulation slows further.
The pattern can change over time. It may be more obvious when the person is lying still or when the room is cool.
Is it painful?
Mottling itself is not usually painful. It reflects reduced blood flow. The person may be very sleepy or unconscious and may not be aware of the skin change.
Still, do not dismiss distress. Ask for review if the person grimaces, moans, becomes restless, pulls away, sweats, has a fever, or seems breathless or frightened.
What you can do
Keep the person comfortable. A light blanket or socks may help if they seem cold. Remove layers if they seem hot, sweaty or uncomfortable.
Avoid rubbing the skin hard. Skin near the end of life can be fragile. Do not use heat packs, hot water bottles or electric blankets unless the care team says they are safe.
Tell the team when you first notice the change. They may explain what it means in the person's overall pattern.
Does mottling mean death is about to happen?
Mottling can happen in the last hours or days, but timing is uncertain. Some people die soon after mottling appears. Others live longer.
The care team will look at several signs together: wakefulness, breathing, pulse, swallowing, urine, skin, comfort and the underlying illness.
What to ask
Useful questions include:
- "Is this mottling?"
- "Does it mean they are close to death?"
- "Do they look comfortable?"
- "Should we change blankets or room temperature?"
- "Who should we call if things change tonight?"
When to get help now
Contact the palliative care team, GP, nurse or aged care staff if the skin change comes with distress, sudden severe breathlessness, new pain, fever, agitation, bleeding, a fall or a seizure.
Call 000 if this is a sudden collapse or unexpected emergency and the person is not expected to be dying, or if there is no plan and you need emergency help.
You may also want to read
- Why are a dying person's hands and feet becoming cold?
- Why has a dying person stopped passing much urine?
- How can I tell if someone is dying?
- How long does someone have once these changes start?