What You Need to Know About Peripheral Cyanosis (Blue Hands and Feet) (2024)

Peripheral cyanosis affects the fingers and toes. It happens when the body is not able to pump oxygen-rich blood to those areas, whether due to the cold or a health condition.

Cyanosis refers to a bluish, purplish, or grayish cast to the skin and mucous membranes. A type known as peripheral cyanosis, or acrocyanosis, primarily affects the hands and feet.

Sometimes cold temperatures can cause the narrowing of blood vessels and lead to blue-tinged skin. Warming or massaging the blue areas should return the necessary blood flow and color to the skin.

If warming up your hands and feet doesn’t restore blood flow and color, you may have an underlying condition.

Whatever the cause, the discoloration means that something’s interfering with your body’s ability to deliver oxygen-rich blood to the tissues that need them. It’s important to restore oxygen to body tissues as soon as possible to prevent complications.

Blood that’s rich in oxygen is the bright red color typically associated with blood. When blood has a lower level of oxygen and becomes a darker red, more blue light is reflected, making the skin appear to have a blue or gray tint.

Being cold is the most common cause of blue hands or feet. It’s also possible to have blue hands or feet even though your extremities are warm.

Peripheral cyanosis can signal an issue with your body’s system of delivering oxygen-rich blood to the tissues of your hands and feet. It may also be the result of low oxygen levels in the red blood cells.

Your blood is responsible for carrying oxygen through your body, traveling from your lungs to your heart. There, it is pumped through your arteries to the rest of your body.

After blood is delivered to your body’s tissues, the oxygen-depleted blood returns to your heart and lungs through your veins.

If anything prevents blood from returning to your heart through your veins or stops blood from reaching your tissues in the first place, your tissues won’t get the oxygen-rich blood they need.

Contributing conditions

Conditions that may cause of blue hands or feet include:

• clothing or jewelry that’s too tight
• hypovolemia, in which less blood circulates through your body than typical
• atherosclerosis, or plaque in the arterial walls
• cholesterol embolism (atheroembolism), which occurs when plaque deposits break off and move, potentially peripherally to the hands and feet
• arterial insufficiency, which is caused by conditions that slow blood flow through your arteries
• venous insufficiency, which is caused by conditions that slow blood flow through your veins
• deep vein thrombosis (DVT), which occurs when a blood clot forms deep in your body
• Raynaud’s phenomenon, which is decreased blood flow to areas such as the fingers
• Buerger’s disease (thromboangiitis obliterans), a rare inflammatory disease of the blood vessels that can affect people who smoke
• lymphedema, which is swelling caused by the buildup of lymphatic fluid
• heart failure, when the heart is unable to pump a sufficient amount of blood throughout the body
• seizures, which are changes in the brain’s electrical activity
• severe hypotension, or extremely low blood pressure, which may be caused by conditions such as septic shock
• conditions that cause hyperviscosity (blood thickening), including blood cancers and disorders such as:
  • multiple myeloma
  • Waldenstrom’s disease
  • polycythemia

Hemoglobin levels typically range from 12.0 to 15.5 grams per deciliter (g/dL) for females and 13.5 to 17.5 g/dL for males, according to the American Red Cross.

Cyanosis is typically noticeable when the concentration of deoxygenated hemoglobin is at least 3 to 5 g/dL.

Peripheral cyanosis typically affects the hands, fingertips, and toes. It is rarely life threatening. Unlike some other types of cyanosis, it doesn’t typically affect the mucous membranes. In some cases, cyanosis can affect the skin around the mouth.

In some people, the affected areas may appear purplish instead of bluish.

According to the NHS, in people with darker skin, cyanosis may be easier to see under the nails, around the eyes, and under the lips, tongue, and gums.

Bluish skin can be a sign of something serious. If your natural color doesn’t return when your skin is warmed, seek medical attention right away.

To determine a cause, a doctor will need to perform a physical examination. They may listen to your heart and lungs. You may have to provide a blood sample and undergo other tests.

A doctor may use or order:

• a noninvasive pulse oximeter to measure the oxygenation of your blood
• an arterial blood gas test to measure the acidity and the levels of oxygen and carbon dioxide in your blood
• a chest X-ray or CT scan to evaluate your heart and lungs

Treatment involves identifying and correcting the underlying cause to restore the oxygenated blood flow to the affected parts of the body.

Some medications can help relax the blood vessels. They may include:

• antidepressants
• antihypertension drugs
• erectile dysfunction drugs

Using these medications to treat peripheral cyanosis is considered off-label drug use.

Off-label drug use

Off-label drug use means that a drug that’s been approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of medications, but not how doctors use them to treat their patients.

So, a doctor can prescribe a drug in whatever way they think is best for your care.

You may also need to avoid certain medications that constrict blood vessels as a side effect, including types of:

• beta-blockers
• migraine medications
• birth control pills
• pseudoephedrine-based cold and allergy medications

Serious medical situations, such as heart failure, may be treated in a hospital as an emergency.

Other conditions, such as Raynaud’s phenomenon, may require longer-term lifestyle changes. You may need to avoid caffeine and nicotine, both of which can cause your blood vessels to constrict.

Peripheral cyanosis is most often caused by cold weather. Once your body warms up, your discolored hands or feet should return to their natural color.

However, it’s also possible that an underlying condition is causing the discoloration. Seek immediate medical attention if that seems to be the case, or if you have other notable symptoms, such as trouble breathing.

Getting a proper diagnosis and treatment in a timely manner will improve your outcome and limit any complications.