Skin Mottling in Dark-skinned Indian Patients with Severe Septic Shock: A Window to the Circulation or a Closed Door?

Skin mottling has been found to be useful as a marker of peripheral hypoperfusion in shock in studies performed on fair-skinned patients. Whether skin mottling may be less apparent in dark-skinned patients, thus limiting its value in this patient population has not been studied. Jog et al. have performed an elegant study addressing this question, which is important and especially relevant to the Indian situation. They found that mottling is not easily visible in dark-skinned Indian patients, and when it becomes apparent, it is associated with a very high mortality. This study also throws up some areas for future research, including interobserver variability in the detection of mottling, and the hemodynamic and microcirculatory parameters associated with the appearance of mottling. Based on this study, the utility of skin mottling as a tool to guide hemodynamic management in severe septic shock in dark-skinned Indian patients is questionable.