Is Acrocyanosis Normal or Abnormal?

Acrocyanosis is when your hands and feet turn blue because blood vessels are constricted. The two kinds of acrocyanosis are primary and secondary.

Primary acrocyanosis typically isn't serious and can be due a blood vessel abnormality or changes in your environment. It's common in newborns as their circulation changes in the first hours of life. Secondary acrocyanosis can be a sign of an underlying medical condition that needs treatment.

This article will cover the symptoms and causes of primary and secondary acrocyanosis and how it is diagnosed and treated.

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Types and Symptoms of Acrocyanosis

If you have ever gotten out of a cold pool and noticed a blue tinge in your hands and feet, then you’ve had acrocyanosis. Acrocyanosis does not hurt but it can be alarming to see. It can be the result of a blood vessel abnormality, but it’s most often from something in your environment—like cold temperatures.

The hands and feet are most commonly affected in acrocyanosis. However, the condition can also affect the nose, ears, lips, nipples, wrists, and ankles.

The most common symptoms of acrocyanosis are:

• Blue-colored fingers or toes
• Cold and sweaty hands and feet
• Low skin temperatures
• Slow blood flow
• Swelling in hands and feet

The symptoms of acrocyanosis will get better with warm temperatures and get worse with cold temperatures. Skin color may get better with movement, especially when it’s in the hands.

Depending on the type of acrocyanosis, the symptoms may affect one or both sides of the body:

• Primary acrocyanosis: May affect both sides of the body equally (e.g., if one palm is blue, the other one is too)
• Secondary acrocyanosis: Only one side of the body is affected and skin color changes. In this case, a person may have pain and potentially tissue loss. Secondary acrocyanosis is usually linked to a specific disease or reaction to a medication. 
  

What Causes Acrocyanosis?

Primary acrocyanosis is caused by constriction of the small blood vessels that deliver oxygen-rich blood to the extremities. Secondary acrocyanosis, which is less common, can be due to an underlying medical condition.

Acrocyanosis can happen to anyone, but it seems to be more common in women. Primary acrocyanosis is common in newborns in their first few hours of life as their circulation changes.

Primary Acrocyanosis

In primary acrocyanosis, the constriction may be due to:

• Cold temperatures
  
• Living in areas of high altitudes with lower oxygen pressure as well as increased cold temperatures and wind
• Genetic defects in the blood vessels
• Changes in circulation after birth 

Secondary Acrocyanosis

The most common causes of secondary acrocyanosis are Raynaud’s disease and eating disorders.

Other causes of secondary acrocyanosis include:

• Infections (Chikungunya virus) 
• Vascular diseases (including peripheral artery disease)
• Blood disorders (cold agglutinin disease, antiphospholipid syndrome) 
• Eating disorders (especially anorexia nervosa) 
• Cancer
• Spinal cord injuries
• Connective tissue disease
• Genetic conditions
• Medications (including Reglan, Tofranil, Norpramin, Prozac and other antidepressants, Ergot alkaloids; some kinds of liposuction, IV chemotherapy)
  

Diagnosis 

A provider can diagnose acrocyanosis by looking at your skin, talking to you about your symptoms, and taking your medical history. If they think there is a specific condition that’s causing the discoloration, they may want to do more tests (like blood work) to look for signs of those problems. 

Primary acrocyanosis is usually a harmless condition that does not cause any long-term problems. However, the underlying causes of secondary acrocyanosis can be more serious and may need specific medical treatment. 

Physical Exam

To make a diagnosis of primary acrocyanosis, your provider will look to see if there is a bluish color in your hands and feet (and sometimes your nose and ears). The color would show up when your hands and feet are cold and sweaty and do not cause you pain.

If there is no pain, it’s a sign that the blue color is not from a disease of impaired blood circulation.  

Testing

Acrocyanosis testing is usually not necessary. Rarely, circulation in the small blood vessels can be measured with a non-invasive test called capillaroscopy. The test looks at the capillaries at the nailbeds.

If your provider thinks you have secondary acrocyanosis, they will talk to you about what conditions or problems they think could be causing it.

There are usually specific tests that can be done to help them either diagnose those conditions or rule them out as a possible cause. For example, one test looks for blood markers of antibodies linked to autoimmune diseases like RA and lupus.

Acrocyanosis Treatment 

There is no specific treatment for acrocyanosis but the symptoms can be managed. 

In newborns, the condition goes away on its own or can be resolved by warming the infant’s body temperature. Once symptoms go away, acrocyanosis in babies usually does not come back.

In older children and adults, keeping the hands and feet warm with thermal socks and mittens can protect them from cold temperatures and help prevent discoloration.

Severe cases of acrocyanosis might need to be treated with medications like alpha blockers, calcium channel blockers, topical nitroglycerin ointment, or medicines that relax muscles and help the small blood vessels stay open. 

Secondary acrocyanosis symptoms will need to be treated based on what the underlying cause is. 

Prognosis 

Acrocyanosis is usually not a serious problem and often gets better on its own. Primary acrocyanosis in babies usually goes away on its own in a few days and never is a problem again. 

People who get acrocyanosis when they’re older usually don’t have any pain from it and can manage the discoloration with some simple lifestyle changes that help them keep their hands and feet warm. 

Secondary acrocyanosis symptoms will usually get better when the underlying condition is diagnosed and properly treated.

Summary

Acrocyanosis is a blue discoloration of the hands and feet (and sometimes other parts of the body) that happens when blood vessels get constricted. It’s usually not a serious issue and won’t be painful. However, it can also be a sign of an underlying medical condition that needs treatment.

If you notice skin discoloration, it’s best to have your provider check it out. It might be something that’s easy to fix with some strategies to keep warm. If there’s another condition causing it, the discoloration will likely improve once that condition is diagnosed and managed.