An Overview of Peripheral Cyanosis

Blue fingertips can be a sign of peripheral cyanosis, a condition in which the extremities develop a distinctive bluish discoloration because they are not receiving enough oxygen-rich blood. Aside from fingers, the condition most often shows up in the hands, feet, and/or toes, with reduced blood circulation most often the cause.

Peripheral cyanosis is rarely serious. But if your hands and feet don’t return to their usual color and blood flow doesn't normalize after warming and massaging, you may have an underlying condition. In this case, you should seek medical attention.

This article outlines the symptoms and causes of peripheral cyanosis. It also explains how it is diagnosed and treated.

Peripheral Cyanosis Symptoms

Peripheral cyanosis can affect anyone, regardless of age.

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

• Bluish areas that feel cold to the touch
• Fingertips, toes, palms of the hands and/or feet that appear blue-green
• Visible return to normal color after the body part is warmed

Peripheral cyanosis is often associated with being cold, but it is possible to have peripheral cyanosis and be warm.

Peripheral cyanosis is sometimes hard to diagnose in newborns because of other skin discoloration issues, including jaundice.

Peripheral Cyanosis Escalation

The causes of central cyanosis (generalized bluishness of the entire body that can evolve into a life-threatening situation) can also cause peripheral cyanosis. For this reason, it is essential to realize the signs of a life-threatening emergency:

• Chest pain
• Dizziness or fainting
• Excessive sweating
• Fever
• Headache
• Pain or numbness in the arms, legs, hands, feet, fingers, or toes
• Shortness of breath and/or other breathing issues
• White or pale appearance in the arms, legs, hands, feet, fingers, or toes (a sign of obstructed blood flow)
  

Peripheral Cyanosis Causes

Most often, the condition is caused by low levels of oxygen in the blood, clinically known as hypoxia. This occurs when not enough oxygen travels from the lungs to the blood.

Blood oxygen levels typically must fall below 80% to 85% for the skin to take on the bluish tint that characterizes cyanosis.

Other common causes of peripheral cyanosis may include: 

• Arterial insufficiency: Sluggishness/stoppage of blood flow to the arteries
• Deep vein thrombosis (DVT): A blood clot in a vein deep inside the body
• Heart failure: Affects the heart’s ability to pump enough blood to the body
• Hypovolemia: A decrease in blood volume throughout the body
• Lymphedema: Causes dysfunction in the lymphatic system, resulting in swelling in the arms or legs and fluid retention in the fingers or toes
• Raynaud’s phenomenon: Causes restricted blood flow to the fingers, toes, ears, and/or nose in response to cold or stress
• Severe hypotension: Low blood pressure
• Septic shock: A life-threatening situation in which a body-wide infection causes extremely low blood pressure
  
• Venous insufficiency: When valves in the blood vessels of the legs don't work as they should, causing blood to pool

Tight clothing or jewelry can also cause peripheral cyanosis.

Cyanosis in newborns may be related to heart, nerve, lung, or metabolic function problems.

Peripheral Cyanosis vs. Central Cyanosis

Both peripheral cyanosis and central cyanosis are signs of hypoxia—low levels of oxygen in the blood.

Peripheral cyanosis affects the extremities, especially the fingers and toes. Central cyanosis shows up as bluish discoloration of the entire body, especially in mucus membranes such as the lips.

Diagnosis

Bluish skin usually isn't a serious condition. However, any time skin color does not return to normal after warming and massaging, it's important to learn the cause.

A healthcare provider should be able to identify the underlying cause after a physical examination, listening to the heart and lungs, and ordering blood work.

A computerized tomography (CT) scan and X-ray can determine if there are abnormalities in the lungs and heart.

A pulse oximeter, which measures the oxygen concentration in the blood, is a helpful tool that is used. 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.

Treating Peripheral Cyanosis

Treatment starts by identifying and correcting the underlying reasons for the 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 drugs typically used for erectile dysfunction.

Medications that restrict blood flow—including beta blockers, birth control pills, and drugs containing pseudoephedrine (cold and allergy medications)—should be avoided by those experiencing bluish skin.

It's also a good idea to limit caffeine consumption and quit smoking. Both are known to constrict blood vessels and slow 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. Up to 4.3% of newborns require oxygen treatment for the condition.

Summary

Peripheral cyanosis is the medical term for the hands, feet, fingers, and/or toes turning blue.

People of any age can develop this temporary condition, which usually disappears after the affected area is warmed or massaged. If it doesn't, there may be an underlying issue that needs diagnosis and treatment.

Certain symptoms signal that peripheral cyanosis might be life-threatening, including chest pain, dizziness, and shortness of breath. Call 911 or seek immediate medical treatment if this happens to you.