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Peripheral Cyanosis (Blue Hands and Feet)

What is peripheral cyanosis?

Fast facts

  1. Peripheral cyanosis means blue hands or feet.
  2. It can be caused by conditions that prevent oxygen-rich blood from reaching the tissues in your hands and feet.
  3. Blue hands or feet may be a sign of an underlying condition. Talk to your doctor if normal color doesn’t return to your hands or feet when you warm them up.

Cyanosis refers to a bluish cast to the skin and mucous membranes. Peripheral cyanosis is when there is a bluish discoloration to your hands or feet. It’s usually caused by low oxygen levels in the red blood cells or problems getting oxygenated blood to your body. 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 tint.

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

If warming your hands or feet up doesn’t restore normal blood flow and color, it may be a sign of an underlying condition. Whatever the underlying cause is, the blue coloring means that it’s interfering with your body’s ability to deliver oxygen-rich blood to all the tissues that need them. It’s important to restore oxygen to body tissues as soon as possible in order to prevent complications.

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Pictures

Pictures of blue hands and feet

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When to call 911

Recognizing a medical emergency

In many cases, blue lips or skin can be a sign of a life-threatening emergency. If the blue discoloration is accompanied by any of the following, call 911:

  • air hunger or gasping for breath
  • fever
  • headache
  • shortness of breath or breathing difficulties
  • chest pain
  • sweating profusely
  • pain or numbness in the arms, legs, hands, fingers, or toes
  • pallor or blanching of the arms, legs, hands, fingers, or toes
  • dizziness or fainting
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Causes

Causes of blue hands or feet

Being cold is the most frequent cause of blue hands or feet. It’s also possible to have blue hands or feet even though they’re warm.

Blue hands or feet can be a sign of an issue with your body’s system of delivering oxygen-rich blood to the tissues of your hands and feet. Your blood is responsible for carrying oxygen through your body, traveling from your lungs to your heart, where it is pumped through your arteries out to the rest of your body. Once it has delivered the blood to your body’s tissues, the oxygen-depleted blood returns to your heart and lungs through your veins.

Anything that prevents blood from returning to your heart through your veins, or that stops it from reaching your tissues in the first place, means that your tissues aren’t getting the oxygen-rich blood they need.

Causes include:

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Diagnosis

Diagnosing blue hands or feet

Bluish skin is usually a sign of something serious. If normal color doesn’t return when your skin is warmed, call your doctor right away in order to determine the cause.

Your doctor will need to perform a physical examination. They will listen to your heart and lungs. You will likely have to provide a blood sample and undergo other tests.

Your doctor may use a noninvasive pulse oximeter to measure the oxygenation of your blood. They may also order an arterial blood gas test. This test measures the acidity and the levels of carbon dioxide and oxygen in your blood. You may have a chest X-ray or CT scan to evaluate your heart and lungs as well.

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Treatment

Treating blue hands or feet

It’s important to seek medical attention if you have blue hands or feet and warming them up doesn’t restore normal color. Treatment involves identifying and correcting the underlying cause in order to restore the oxygenated blood flow to the affected parts of the body. Receiving proper treatment in a timely manner will improve the outcome and limit any complications.

There are some medications available that can help blood vessels relax. These include:

  • antidepressants
  • antihypertension drugs
  • erectile dysfunction drugs

Learn more about off-label prescription drug use »

Using these drugs to treat peripheral cyanosis is considered off-label drug use. Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not 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, your doctor can prescribe 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 medicines

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. 

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