Acrocyanosis is a painless condition that causes the small blood vessels in your skin to constrict and turns the color of your hands and feet bluish. Acrocyanosis is common in newborn babies but can also affect teens and young adults.

The blue color comes from the decrease in blood flow and oxygen moving through the narrowed vessels to your extremities (outer limbs).

Medical scientists first coined the term in 1896, according to a 2016 research review, but acrocyanosis is still not well understood or studied.

There are two types of acrocyanosis: primary and secondary.

Primary acrocyanosis has links to cold temperature and emotional stress. Doctors don’t consider it to be harmful.

Secondary acrocyanosis develops due to many different underlying diseases, according to 2011 research. These include eating disorders, psychiatric illnesses, and cancer.

The term “acrocyanosis” comes from the Greek words “akros” (extreme) and “kyanos” (blue).

Hands and feet are the extremities most often affected by acrocyanosis. But its symptoms can develop in several different areas, including your:

  • wrists
  • ankles
  • nose
  • ears
  • lips
  • nipples

The symptoms are symmetrical in primary acrocyanosis, affecting both hands or both feet. In secondary acrocyanosis, symptoms often affect only one side, may be painful, or may involve tissue loss.

The most common symptoms are:

  • bluish-colored fingers or toes
  • cold, clammy, and sweaty hands and feet
  • lower skin temperatures and blood flow
  • swelling of hands and feet
  • a “normal” pulse

Symptoms worsen with cold and improve with warmth. Finger color goes back to usual when you move your hands to a horizontal position, from hanging down.

Most newborns have blue hands and feet right after birth and in their first few hours, according to experts.

The acrocyanosis symptoms may come back when the baby is cold or when the baby first comes out of a bath. However, the condition doesn’t persist in infants.

What does acrocyanosis look like?

People with acrocyanosis might have extremities that look like the following:

Primary acrocyanosis

There isn’t much specific research on the causes of acrocyanosis. A 2011 study reported a lack of clarity in the medical community about whether acrocyanosis is a single disease or a condition that varies by cause.

The current understanding around primary acrocyanosis is that it occurs due to the constriction of small blood vessels. This decreases the flow of oxygen-rich blood to your extremities.

This constriction, or vasospasm, might have several reasons for developing, including:

  • cold temperatures
  • living in a high altitude with a combination of lower oxygen pressure, increased wind, and cold
  • a genetic anomaly that affects your blood vessels

As newborns get used to the change in blood circulation between the womb and the outside world, they might show signs of acrocyanosis. At first, oxygen-rich blood circulates to the brain and other organs rather than the hands and feet.

However, it’s hard to confirm the true root of acrocyanosis until more research takes place.

Secondary acrocyanosis

There is more research around secondary acrocyanosis because studies have examined the underlying primary diseases. In some cases, acrocyanosis may be the first sign of the primary disease.

The causes of secondary acrocyanosis vary widely and include:

  • vascular disorders
  • infections
  • blood disorders
  • solid tumors
  • genetic diseases
  • some medications

Specific health factors that cause second acrocyanosis

Different conditions can trigger the effects of acrocyanosis in different ways, including:

  • Raynaud’s phenomenon. This is the most common underlying cause, in which the extremities turn pale, then blue, then red.
  • Anorexia. When a person lives with anorexia, excessive weight loss may impair their body’s heat regulation. An estimated 21 to 40 percent of people with anorexia have acrocyanosis.
  • Ergot alkaloid drugs. People use these to treat migraine episodes and headaches. But one of their side effects is acrocyanosis.
  • Chikungunya. This mosquito-borne viral infection can cause acrocyanosis.
  • Various types of cancers. Up to 24 percent of people with cancer have acrocyanosis.

Your doctor will ask you about your medical history and symptoms, then conduct a physical examination. They will base your diagnosis of primary acrocyanosis on your hands and feet (and sometimes nose and ears) being:

  • blue-colored
  • pain-free
  • cold
  • sweaty

The doctor may also order a capillaroscopy, a noninvasive technique that measures the circulation in the small vessels of your nail bed.

They may perform other tests to rule out Raynaud’s phenomenon and chilblains, two conditions that also involve bluish extremities. Having a “normal” pulse indicates that the blue tint has not occurred due to an arterial disease that reduces blood circulation.

If your physician suspects secondary acrocyanosis, they will order other laboratory testing and imaging procedures to determine the underlying disease.

The majority of people with primary acrocyanosis won’t require treatment.

Primary acrocyanosis

There’s no standard treatment for primary acrocyanosis. Few clinical trials have looked at the effectiveness of treatment.

However, doctors tend to use some of the following approaches when helping you manage acrocyanosis:

  • Warming measures. With newborns and infants, warming the baby is an effective treatment. Acrocyanosis is common in infants and not especially harmful. For others, a healthcare professional will likely advise you to keep your hands and feet warm indoors and to protect yourself against exposure to cold temperatures.
  • Some medications. In people with severe acrocyanosis, doctors have used alpha-blocker and calcium channel blocker drugs, topical nicotinic acid derivatives, or minoxidil to ease symptoms.
  • Reassurance and patience. The medical literature stresses that it’s important for doctors to reassure their patients that the condition is not harmful.

Secondary acrocyanosis

Treating the underlying disease may improve the symptoms of acrocyanosis.

If your symptoms are occurring due to medication like an ergot alkaloid, you might benefit from speaking with your doctor about other medications or treatments if you have concerns about acrocyanosis and other side effects.

Primary acrocyanosis is an uncommon and benign condition with a good outlook. Some treatments are available that may lessen symptoms in severe cases.

In newborns, acrocyanosis is typical and resolves without treatment.

Secondary acrocyanosis can be serious, depending on the underlying cause. See your doctor if you have symptoms of acrocyanosis. They can determine whether there’s an underlying condition that needs treatment.