The skin often shows visible physical changes when the body’s systems begin to shut down in the advanced stages of a serious illness. These changes result from a profound shift in internal function, primarily the decline of the cardiovascular system. As the heart weakens and blood pressure drops, the body conserves resources by redirecting blood flow away from the periphery to support vital organs like the brain and heart. Understanding the physiological basis of these external changes provides clarity.
Visual Indicators of Circulatory Failure
One of the first signs of reduced peripheral circulation is pallor, an extreme paleness resulting from the body pulling blood away from the skin’s surface. This loss of hue is a direct result of decreased blood flow. As circulation slows, the skin may develop a bluish or grayish tint, known as cyanosis, most often observed in the nail beds, lips, and around the mouth.
This bluish color occurs because the blood pooling in the capillaries is deoxygenated. A more pronounced visual change is livedo reticularis, commonly referred to as mottling or marbling of the skin. This appears as a net-like, blotchy, reddish-blue or purplish pattern caused by the stagnation of blood in small vessels.
Mottling typically begins on the feet, hands, and lower extremities. It gradually progresses upward toward the torso as the body’s ability to circulate blood diminishes. Livedo reticularis is a late-stage sign of severely compromised blood flow and signifies the systemic withdrawal of blood from the extremities.
Changes in Skin Temperature and Texture
Concurrently with the visual changes, the skin’s physical feel and structural integrity shift. The withdrawal of blood from the extremities causes the skin to feel significantly cooler to the touch, especially in the hands and feet. The skin’s surface temperature drops substantially due to the lack of warm, circulating blood.
This cooling may be accompanied by a clammy or moist feeling due to changes in temperature regulation. The skin frequently becomes noticeably dry and thin, sometimes appearing flaky, often related to decreased hydration intake.
The skin also becomes more fragile and delicate, a structural change known as skin failure. This increased fragility makes the skin highly susceptible to bruising and tearing, even from minor pressure or friction. Reduced blood flow means the skin and underlying tissues are not receiving the necessary oxygen and nutrients to maintain integrity. Gentle handling is important because this systemic compromise can lead to skin breakdown from minor trauma.
Managing Skin-Related Discomfort
A primary focus of care is to maintain comfort and dignity, as these skin changes cannot be reversed.
Addressing Dryness and Fragility
For dryness and fragility, gentle moisturizing with non-fragrant emollients or lotions is recommended to maintain the skin’s barrier function. Caregivers should apply these products sparingly using a soft, patting motion rather than rubbing, which can damage the fragile skin.
Managing Temperature and Cleansing
For the coolness of the extremities, using light blankets or socks provides warmth and comfort. Avoid using electric blankets or direct heat sources like heating pads. Reduced circulation impairs the body’s ability to sense high temperatures, creating a risk of burns. Skin cleansing should be done with tepid water and mild soaps, followed by patting the skin dry.
Preventing Pressure Injuries
Proper positioning is a necessary comfort measure to prevent pressure and minimize the risk of skin breakdown, particularly over bony prominences. Frequent, gentle repositioning helps to redistribute pressure and should be done with minimal dragging or pulling on the skin. Consulting with a palliative care team can provide guidance on specific techniques for managing skin changes.