Hello, Just to recap - your daughter has malar rash, positive ACL antibodies and temperature-sensitive mottled skin on her extremities. She is very young but unfortunately of the right gender for risk of autoimmune diseases like SLE. She needs extensive workup with full blood count (to exclude cytopenias), ANA profile, dsDNA, brain scan (if any history of fevers with fits), cryoglobulin screen with typing (if positive). Cryoglobulin is a type of protein that clots when skin temperature falls below core temperature and therefore very important to keep extremities warm at all times. You need to ensure she is reviewed by a Paediatric Rheumatologist asap.