Bluish discoloration of the skin may signal a lack of oxygen in the blood. It could also indicate an abnormal form of hemoglobin (a protein in red blood cells) like it does with sickle cell anemia.

Cyanosis is the name for poor oxygen circulation in the blood that causes bluish discoloration of the skin. Central cyanosis affects the lips, but it can also affect the tongue and chest.

Blue lips may indicate a type of cyanosis caused by lower levels of oxygen in the red blood cells. Blue lips may also represent high levels of an abnormal form of hemoglobin in the bloodstream (similar to bluish discoloration of the skin).

If normal color returns with warming or massage, your lips aren’t getting enough blood supply. Blue lips might not be due to cold or constriction.

If the lips remain blue, then there may be an underlying disease or structural abnormality. Either of these can interfere with the body’s ability to deliver oxygenated red blood to all areas.

The most common causes of blue lips are events that limit the amount of oxygen that the lungs take in, including:

  • air passage blockage
  • choking
  • excessive coughing
  • smoke inhalation

Congenital (present at birth) heart abnormalities can also cause cyanosis and the appearance of blue lips.

Less-common causes of blue lips include polycythemia vera (a bone marrow disorder that causes the production of excess red blood cells) and cor pulmonale (a decrease in the function of the right side of the heart caused by long-term high blood pressure). Septicemia, or blood poisoning caused by bacteria, may also lead to blue lips.

Cold weather conditions, vigorous exercise, and becoming “winded” from physical exertion can sometimes cause a temporary blue appearance in the lips.

Cyanosis that’s only found in the areas around the lips, hands, and feet is called acrocyanosis. It isn’t a cause for concern in children under the age of 2. But if the tongue, head, torso, or lips themselves appear bluish, the child needs to be examined by a doctor.

Blue lips in children under 2 years old can be a symptom of a respiratory syncytial virus (RSV) infection. Though an RSV infection is common and most kids have the virus at some point before their 2nd birthday, don’t assume that this is what’s causing the lip discoloration.

If your child’s lips are discolored, make sure that a pediatrician examines your child.

In some cases, blue lips can signal a serious blood and respiratory condition. In other cases, blue lips indicate chemical poisoning as a result of ingesting antifreeze or ammonia. It’s essential that your child receive the correct diagnosis before they begin any sort of treatment.

Many different conditions can cause blue lips. Here are 15 possible causes.

Warning: Graphic images ahead.

Cyanosis

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James Heilman, via Wikimedia Commons

This condition is considered a medical emergency. Seek care immediately.

  • This bluish discoloration of the skin and mucous membranes is caused by decreased oxygenation or poor circulation.
  • It may occur rapidly due to an acute health problem, or slowly over time as a chronic condition gets worse.
  • Many health disorders that involve the heart, lungs, blood, or circulation will cause cyanosis.
  • Most causes of cyanosis are serious and a sign that your body isn’t getting enough oxygen.

Learn more about cyanosis.

Acute mountain sickness

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  • This illness is caused by the low levels of oxygen and decreased air pressure found at high elevations.
  • Typically, it occurs at about 8,000 feet (2,400 meters) or higher above sea level.
  • Mild symptoms include:
    • dizziness
    • headache
    • muscle aches
    • insomnia
    • nausea
    • vomiting
    • irritability
    • loss of appetite
    • shortness of breath with exertion
    • increased heart rate
    • swelling of the hands, feet, and face
  • Severe symptoms are due to fluid accumulation in the lungs and brain and include:
    • coughing
    • chest congestion
    • pale complexion and skin discoloration
    • inability to walk or lack of balance
    • confusion and social withdrawal

Learn more about acute mountain sickness.


Aspiration pneumonia

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  • Aspiration pneumonia is a lung infection caused by accidentally inhaling food, stomach acid, or saliva into the lungs.
  • It’s more common in people with impaired coughing or swallowing ability.
  • Symptoms include:
    • fever
    • cough
    • chest pain
    • shortness of breath
    • wheezing
    • fatigue
    • difficulty swallowing
    • bad breath
    • excessive sweating

Learn more about aspiration pneumonia.


Chronic obstructive pulmonary disease (COPD)

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  • Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease caused by alveolar (air sac) and airway damage.
  • Early symptoms of COPD are mild, but get gradually worse over time.
  • Early symptoms include:
    • occasional shortness of breath, especially after exercise
    • mild but recurrent cough
    • needing to clear your throat often, especially first thing in the morning
  • Other symptoms include:
    • shortness of breath after even mild exercise, like walking up a flight of stairs
    • wheezing or noisy breathing
    • chest tightness
    • chronic cough with or without mucus
    • frequent colds, flu, or other respiratory infections

Learn more about chronic obstructive pulmonary disease (COPD).


Emphysema

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  • Emphysema is one of the two most common conditions that fall under the COPD umbrella.
  • It’s caused by the destruction of alveoli (air sacs) in the lungs.
  • Symptoms include shortness of breath and coughing, especially during exercise or physical exertion.
  • Severe symptoms include bluish-gray lips or fingernails from lack of oxygen.

Learn more about emphysema.

Pulmonary edema

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  • Pulmonary edema is a condition in which the lungs fill with fluid.
  • Increasing fluid in the lungs prevents oxygen from moving into the bloodstream and makes it more difficult to breathe.
  • It may be caused by a variety of health conditions, but people with heart conditions have a higher risk of developing pulmonary edema.
  • Symptoms include:
    • shortness of breath when being physically active
    • difficulty breathing when lying down
    • wheezing
    • rapid weight gain (especially in the legs)
    • swelling in the lower part of the body
    • fatigue

Learn more about pulmonary edema.


Respiratory syncytial virus (RSV)

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  • Respiratory syncytial virus (RSV) is a common virus that most appears in children and infants.
  • 58,000 children under 5 are hospitalized each year with RSV.
  • Adults over 65 are also at risk. Each year an estimated 177,000 are hospitalized with RSV.
  • Since RSV is a virus, it cannot be treated with antibiotics. Most cases resolve without treatment.
  • Common symptoms include fever, congestion, and cough. A less common symptom is bluish skin.

Learn more about respiratory syncytial virus (RSV).


Acute respiratory distress

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This condition is considered a medical emergency. Seek care immediately.

  • Acute respiratory distress is a severe, inflammatory form of lung injury that results in rapid accumulation of fluid in the lungs.
  • Too much fluid in the lungs lowers the amount of oxygen and increases the amount of carbon dioxide in the bloodstream, leading to the damage of other organs.
  • Many different conditions can cause ARDS, including serious infections, drug overdose, inhaling toxic substances, or trauma to the chest or head.
  • The symptoms of ARDS typically appear between 6 hours and 3 days after an inciting illness or injury.
  • Symptoms include:
  • labored and rapid breathing
  • muscle fatigue and general weakness
  • low blood pressure
  • discolored skin or nails
  • fever
  • headaches
  • rapid heart rate
  • confusion

Learn more about acute respiratory distress.


Carbon monoxide poisoning

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This condition is considered a medical emergency. Seek care immediately.

  • Carbon monoxide (CO) is a gas that’s both odorless and colorless, and reduces how efficiently your red blood cells carry oxygen.
  • Inhaling too much CO may lead to organ damage from reduced oxygen.
  • The most common symptoms of CO poisoning are:
    • headache
    • weakness
    • excessive sleepiness
    • nausea
    • vomiting
    • confusion
    • loss of consciousness
  • You should go to the hospital right away if you’ve been exposed to a source of CO, even if you don’t show symptoms of CO poisoning.

Learn more about carbon monoxide poisoning.



Pneumothorax

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This condition is considered a medical emergency. Seek care immediately.

  • Pneumothorax occurs when air enters the space around your lungs (the pleural space).
  • The change in pressure caused by an opening in your chest or lung wall can cause the lung to collapse and put pressure on the heart.
  • The two basic types of pneumothorax are traumatic pneumothorax and nontraumatic pneumothorax.
  • Symptoms include:
    • sudden chest pain
    • a steady ache in the chest
    • chest tightness
    • shortness of breath
    • breaking out in a cold sweat
    • cyanosis
    • severe tachycardia

Learn more about pneumothorax.


Pulmonary embolism

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This condition is considered a medical emergency. Seek care immediately.

  • This type of embolism occurs when a blood clot in a vein travels to the lungs and gets stuck.
  • The blood clot restricts blood flow to parts of the lung, causing pain and preventing oxygen from getting into the body.
  • The blood clots that most often cause pulmonary embolisms begin as a deep vein thrombosis (DVT) in the legs or pelvis.
  • Common symptoms of a pulmonary embolism include:
    • shortness of breath
    • stabbing chest pain when taking a deep breath
    • coughing up blood
    • rapid heart rate
    • dizziness or fainting

Learn more about pulmonary embolisms.


Sickle cell anemia

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  • Sickle cell anemia is a genetic disease of the red blood cells that causes them to take on a crescent moon or sickle shape.
  • Sickle-shaped red blood cells are prone to getting trapped in small vessels, which blocks blood from reaching different parts of the body.
  • Sickle-shaped cells get destroyed faster than normal-shaped red blood cells, leading to anemia.
  • Symptoms include:
    • excessive fatigue
    • pale skin and gums
    • yellowing of the skin and eyes
    • swelling and pain in hands and feet
    • frequent infections
    • episodes of extreme pain in the chest, back, arms, or legs

Learn more about sickle cell anemia.


Asthma

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  • This chronic, inflammatory lung disease causes the airways to narrow in response to triggering events.
  • Airway narrowing may occur due to a variety of stimuli like:
    • viral illness
    • exercise
    • weather changes
    • allergens
    • smoke
    • strong scents
  • Symptoms include:
    • dry coughing
    • high-pitched wheezing
    • tight chest
    • shortness of breath
    • difficulty breathing
  • Symptoms of asthma may be reduced or resolved by using asthma medications.

Learn more about asthma.


Cardiac tamponade

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This condition is considered a medical emergency. Seek care immediately.

  • In this serious medical condition, blood or other fluids fill the space between the sac that encases the heart and the heart muscle.
  • Pressure from the fluid around the heart prevents the heart’s ventricles from expanding fully and keeps the heart from pumping effectively.
  • It’s usually the result of penetrating injury to the pericardium.
  • Symptoms include chest pain radiating to the neck, shoulders, or back, and discomfort that’s relieved by sitting or leaning forward
  • Other symptoms include:
    • swollen veins in the forehead
    • low blood pressure
    • fainting
    • dizziness
    • cold
    • blue extremities
    • loss of consciousness
  • A person with this condition may also experience trouble breathing or taking deep breaths and rapid breathing.

Learn more about cardiac tamponade.


Raynaud’s phenomenon

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  • This is a condition in which blood flow to your fingers, toes, ears, or nose is restricted or interrupted by vasospasms.
  • It may occur on its own or can accompany underlying medical conditions like arthritis, frostbite, or autoimmune disease.
  • Blue or white discoloration of fingers, toes, ears, or nose can occur.
  • Other symptoms include numbness, cold sensation, pain, and tingling in affected body parts.
  • Episodes may last a few minutes or up to several hours.

Learn more about Raynaud’s phenomenon.

Speak to your doctor if you are noticing bluish lips so that they can help determine the cause. Performing a simple pulse oximeter check at home is not an accurate way of getting a diagnosis.

A pulse oximeter is used to determine the concentration of oxygen in your blood by comparing how much “red light” and “infrared light” are being absorbed by your blood. Arterial blood gases are drawn to measure oxygenation and detect other factors that may be contributing to blue lips.

There are times when a pulse oximeter won’t be necessary to find out what’s causing your blue lips. If you’ve already been diagnosed with asthma, emphysema, or another breathing condition, your doctor will probably conclude right away that this is the cause of your blue lips.

Treatment of blue lips involves identifying and correcting the underlying cause and restoring the flow of oxygenated blood to the lips. Once your doctor has reached a diagnosis, one of several things may happen:

  • If you’re taking blood pressure medication, beta-blockers, or blood thinners, the dosage may need to be adjusted. This is to ensure that your white blood cell count and red blood cell count remain balanced.
  • If you have a respiratory condition like emphysema or COPD, it’s possible that blue lips are an indication that your condition has worsened. In that case, your doctor may recommend lifestyle changes like quitting smoking and starting an exercise regimen that will improve your respiratory and vascular health. Pulmonary rehabilitation may be recommended.

Call an emergency hotline immediately if blue lips are accompanied by any of the following symptoms:

If your blue lips occur suddenly and aren’t the result of strenuous exercise or time spent outdoors, call for emergency assistance. If cyanosis comes on gradually, keep an eye on it and schedule an appointment with your general practitioner if it doesn’t subside after a day or two.

If there’s an underlying condition causing your lips to appear blue, the discoloration will go away once the cause is identified and addressed. The amount of time it will take for the blue lips to subside varies widely, depending on what’s causing this symptom.

Lip discoloration doesn’t always indicate an emergency situation, but it’s not a symptom that should be ignored.