An Overview of Peripheral Cyanosis

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Peripheral cyanosis is a type of cyanosis that causes the extremities—usually hands, feet, fingers, and toes—to become discolored. Cyanosis is a medical condition distinguished by bluish discoloration of the skin and mucous membranes. Peripheral cyanosis is rarely a serious condition but anyone whose hands and feet don’t restore to normal color and blood flow after warming and massaging may have an underlying condition and should seek medical attention. 

An underlying cause may mean poor oxygen supply to affected locations. Oxygen-rich blood is a bright red while poor oxygen blood is dark red and will reflect a bluish green color through the skin.

It is vital for oxygen flow to be restored to prevent potential complications. Peripheral cyanosis can affect anyone regardless of age, even newborns.

Research reported in the medical journal BMJ Best Practice finds up to 4.3 percent of newborns who have cyanosis will require oxygen treatment. Cyanosis in newborns may be related to heart, nerve, lung, or cell function problems. Peripheral cyanosis is sometimes hard to diagnose in newborns because of other skin discoloration issues, including jaundice. 

Symptoms

Adults and children with peripheral cyanosis may experience the following symptoms:

  • Skin on the fingertips, toes, palms of the hands and/or feet to appear blue-green
  • Bluish areas that feel cold to touch
  • Returned color after the body part is warmed

Peripheral cyanosis can also be a life-threatening emergency. Anyone experiencing blue discoloration with the following symptoms should seek immediate medical attention by calling 911 or going to the nearest emergency room:

  • Grasping for air, shortness of breath and/or other breathing issues
  • Fever
  • Headache
  • Chest pain
  • Excessive sweating
  • Pain or numbness in the arms, legs, hands, feet, fingers or toes
  • White or pale appearance of the arms, legs, hands, feet, fingers or toes. This symptom is a sign of obstructed blood flow.
  • Dizziness or fainting

Causes

Peripheral cyanosis is often associated with being cold, but it is possible to have this condition and be warm, due to poor oxygenation.   

Common causes for peripheral cyanosis may include: 

  • Tight clothing or jewelry
  • Deep vein thrombosis (DVT), a serious condition causing a blood clot in a vein deep inside the body
  • Venous insufficiency, a condition that causes blood to pool into the veins
  • Heart failure, affecting the heart’s ability to pump enough blood to the body
  • Raynaud’s phenomenon, which causes restricted blood flow to the fingers, toes, ears, and/or nose in response to cold or stress
  • Lymphedema, which causes dysfunction in the lymphatic system resulting in swelling of arms or legs and fluid retention in the fingers or toes. Lymphedema may also affect the head and neck.
  • Arterial insufficiency or the sluggishness/stoppage of blood flow to the arteries
  • Severe hypotension (low blood pressure)
  • Septic shock. Usually the result of an infection, septic shock can be life-threatening.
  • Hypovolemia or a decrease in blood volume throughout the body

Diagnosis

Bluish skin isn’t usually a serious condition. However, any time skin color does not return to normal color, it is important to find out the cause.

A doctor can determine an underlying cause with a physical examination, listening to the heart and lungs, and also with blood work. CT scans and x-rays can determine if there are abnormalities in the lungs and heart.

A non-invasive pulse oximeter is a helpful tool for measuring blood oxygen saturation. Unfortunately, it cannot help determine the metabolism of oxygen or the amount of oxygen a person is using.

Peripheral cyanosis can also be diagnosed using an arterial blood gas test. This test measures acidity, carbon dioxide, and oxygen levels in the blood.

Treatment

Treatment starts by identifying and correcting underlying reasons for constricted blood flow. Timely and appropriate treatment can help reduce any potential complications. 

Medications for treating peripheral cyanosis relax the blood vessels and may include antidepressants, anti-hypertension medications, or erectile dysfunction drugs. Medications that restrict blood flow should be avoided by people with conditions causing bluish skin decoration, including beta blockers, birth control pills, and drugs containing pseudoephedrine (i.e. cold and allergy medications). 

It is also a good idea to limit caffeine consumption and quit smoking as both are known for constricting blood vessels and affecting blood flow.  

Cyanosis in babies tends to go away when the underlying condition is managed. Cases of cyanosis with no known source can be treated with supplemental oxygen. 

A Word From Verywell 

Peripheral cyanosis is rarely a medical emergency. However, it is important to determine the underlying cause and treat the condition appropriately and timely. Ongoing symptoms of bluish and cold skin and restrictive blood flow should be brought to the attention of a doctor to avoid serious and life-threatening complications.

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