Blue discoloration of the skin
Lips - bluish; Fingernails - bluish; Cyanosis; Bluish lips and fingernails; Bluish skinA bluish color to the skin or mucous membrane is usually due to a lack of oxygen in the blood. The medical term is cyanosis.
Considerations
Red blood cells provide oxygen to body tissues. Most of the time, nearly all red blood cells in the arteries carry a full supply of oxygen. These blood cells are bright red and the skin is pinkish or red.
Blood that has lost its oxygen is dark bluish-red. People whose blood is low in oxygen tend to have a bluish color to their skin. This condition is called cyanosis.
Depending on the cause, cyanosis may develop suddenly, along with shortness of breath and other symptoms.
Cyanosis that is caused by long-term heart or lung problems may develop slowly. Symptoms may be present, but are often not severe.
When the oxygen level has dropped only a small amount, cyanosis may be hard to detect.
In dark-skinned people, cyanosis may be easier to see in the mucous membranes (lips, gums, around the eyes) and nailbeds.
People with cyanosis do not normally have anemia (low blood count). Anemia is a condition in which the body does not have enough healthy red blood cells.
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Read Article Now Book Mark ArticleCauses
Cyanosis that is seen in only one part of the body may be due to:
- A blood clot that blocks the blood supply to a leg, foot, hand, or arm
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Raynaud phenomenon (condition in which cold temperatures or strong emotions cause blood vessel spasms, which block blood flow to the fingers, toes, ears, and nose)
Raynaud phenomenon
Raynaud phenomenon is a condition in which cold temperatures or strong emotions cause blood vessel spasms. This blocks blood flow to the affected re...
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Most cyanosis occurs because of a lack of oxygen in the blood. This can be caused by the following problems.
Problems with the lungs:
- Blood clot in the arteries of the lungs (pulmonary embolism)
Pulmonary embolism
A pulmonary embolus is a blockage of an artery in the lungs. The most common cause of the blockage is a blood clot.
Read Article Now Book Mark Article - Drowning or near-drowning
- High altitude
- Infection in the smallest air passages in the lungs of children, called bronchiolitis
Bronchiolitis
Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles). It is usually due to a viral infection....
Read Article Now Book Mark Article - Long-term lung problems that become more severe, such as chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease
Chronic obstructive pulmonary disease (...
Chronic obstructive pulmonary disease (COPD) is a common lung disease. Having COPD makes it hard to breathe. There are two main forms of COPD:Chroni...
Read Article Now Book Mark ArticleAsthma
Asthma is a chronic disease that causes the airways of the lungs to swell and narrow. It leads to breathing difficulty such as wheezing, shortness o...
Read Article Now Book Mark ArticleInterstitial lung disease
Interstitial lung disease (ILD) is a group of lung disorders in which the lung tissues become inflamed and then damaged.
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Pneumonia (severe)
Pneumonia
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...
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Problems with the airways leading to the lungs:
- Breath-holding (although this is exceedingly difficult to do)
- Choking on something stuck in the airways
- Swelling around the vocal cords (croup)
Croup
Croup is an infection of the upper airways that causes breathing difficulty and a barking cough. Croup is due to swelling around the vocal cords. I...
Read Article Now Book Mark Article - Inflammation of the flap of tissue, called the epiglottis, that covers the windpipe (epiglottitis)
Epiglottitis
Epiglottitis is inflammation of the epiglottis. This is the tissue-lined cartilage that covers the trachea (windpipe) while swallowing. Epiglottiti...
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Problems with the heart:
- Heart defects that are present at birth (congenital)
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Heart failure
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Read Article Now Book Mark Article - Heart stops working (cardiac arrest)
Cardiac arrest
Cardiac arrest occurs when the heart suddenly stops beating. When this happens, blood flow to the brain and the rest of the body also stops. Cardia...
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Other problems:
- Drug overdose (narcotics, benzodiazepines, sedatives)
- Exposure to cold air or water
- Seizure that lasts a long time
- Toxins such as cyanide
Home Care
For cyanosis caused by exposure to cold or Raynaud phenomenon, dress warmly when going outside or stay in a well-heated room.
Most other acute episodes of cyanosis need to be diagnosed and treated by a health care provider (office or emergency room).
When to Contact a Medical Professional
Bluish skin can be a sign of many serious medical problems. Contact or visit your provider.
For adults, contact your provider or call the local emergency number, such as 911 if you have bluish skin and any of the following:
- Cannot get a deep breath or your breathing is getting harder, or faster
- Need to lean forward when sitting to breathe
- Are using muscles around the ribs to get enough air
- Have chest pain
- Are having headaches more often than usual
- Feel sleepy or confused
- Have a fever
- Are coughing up dark mucus
- Are unable to speak a full sentence because of shortness of breath
For children, contact your provider or call 911 or the local emergency number if your child has bluish skin and any of the following:
- Hard time breathing
- Moving chest muscles in with each breath
- Breathing faster than 50 to 60 breaths per minute (when not crying)
- Making a grunting noise
- Sitting with shoulders hunched over
- Is very tired
- Moving very little
- Has a limp or floppy body
- Nostrils flare out when breathing
- Does not feel like eating
- Is irritable
- Has trouble sleeping
In general, cyanosis that occurs acutely is more likely to be an emergency than when it is present for a long time.
What to Expect at Your Office Visit
Your provider will perform a physical examination. This will include listening to your breathing and heart sounds. In emergency situations (such as shock), you will be stabilized first.
Shock
Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...
Read Article Now Book Mark ArticleThe provider will ask about your symptoms. Questions may include:
- When did the bluish skin develop? Did it begin slowly or suddenly?
- Is your body blue all over? How about your lips or nailbeds?
- Have you been exposed to cold or have you been at a high altitude?
- Do you have trouble breathing? Do you have a cough or chest pain?
Breathing
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Do you have ankle, foot, or leg swelling?
Ankle, foot, or leg swelling
Painless swelling of the feet and ankles is a common problem, especially among older people. Abnormal buildup of fluid in the ankles, feet, and legs ...
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Tests that may be ordered include:
-
Arterial blood gas analysis
Arterial blood gas analysis
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
Read Article Now Book Mark Article - Blood oxygen saturation by pulse oximetry
-
Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
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Chest CT scan
Chest CT scan
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....
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Complete blood count (CBC)
Complete blood count (CBC)
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Electrocardiogram (ECG)
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Echocardiogram (ultrasound of the heart)
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
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The treatment you receive depends on the cause of cyanosis. For example, you may receive oxygen for shortness of breath.
References
McGee S. Cyanosis. In: McGee S, ed. Evidence-Based Physical Diagnosis. 5th ed. Philadelphia, PA: Elsevier; 2022:chap 9.
Shetty P, Fernández-Frackelton M. Cyanosis. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 10.
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Cyanosis of the nail bed - illustration
Lack of oxygen in the blood causes a bluish discoloration in the skin or mucous membranes called cyanosis. Most cyanosis is seen as a result of congenital heart disease, pulmonary disease, or as a terminal event as in cardiopulmonary arrest.
Cyanosis of the nail bed
illustration
-
Cyanosis of the nail bed - illustration
Lack of oxygen in the blood causes a bluish discoloration in the skin or mucous membranes called cyanosis. Most cyanosis is seen as a result of congenital heart disease, pulmonary disease, or as a terminal event as in cardiopulmonary arrest.
Cyanosis of the nail bed
illustration
-
Melanoma and other skin cancers - InDepth
(In-Depth)
Review Date: 5/3/2023
Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.