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Sepsis is one of the commonest causes of death around the world. The real frequency of cutaneous lesions in the setting of sepsis is unknown, but when they appear, they are usually one of the earliest signs of sepsis, thus allowing a rapid diagnosis of this potentially life-threatening condition. Four are the main physiopathologic mechanisms that can induce cutaneous lesions in sepsis: a) disseminated intravascular coagulation; b) direct vessel wall invasion by the microorganism; c) immune-mediated vasculitis, and d) septic embolism. We know that more than one of these mechanisms can appear in one single patient. In this review, we analyse these four mechanisms, their clinical presentation, and the histological findings that can be found in the cutaneous biopsy.