Bluish discoloration of the skin may signal lack of oxygen in the blood. It could also indicate an abnormal form of hemoglobin (a protein in red blood cells), such as in 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, constriction, or some other reason. 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.

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

Warning: Graphic images ahead.

Acute mountain sickness

Acute mountain sickness

Image by: Dibendu Nandi (Own work) [CC BY-SA 4.0 (creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

  • 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, and 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
Read full article on acute mountain sickness.

Aspiration pneumonia

Aspiration pneumonia

Image by: BruceBlaus [CC BY-SA 4.0 (creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

  • 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, and excessive sweating.
Read full article on aspiration pneumonia.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD)

Image by: Dr. Edwin P. Ewing, Jr. [Public domain], via Wikimedia Commons

  • Chronic obstructive pulmonary disease (COPD) is a chronic, progressive lung disease caused by 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, and needing to clear your throat often, especially first thing in the morning.
  • Other symptoms include shortness of breath, after even mild exercise such as 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.
Read full article on chronic obstructive pulmonary disease (COPD).

Pulmonary edema

Pulmonary edema

Image by: James Heilman, MD [CC BY-SA 3.0 (creativecommons.org/licenses/by-sa/3.0) or GFDL (gnu.org/copyleft/fdl.html)], from Wikimedia Commons

  • 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, and fatigue.
Read full article on pulmonary edema.

Respiratory syncytial virus (RSV)

Image by: Philippe Put/Flickr

  • Respiratory syncytial virus (RSV) is a chronic skin disease that goes through cycles of fading and relapse.
  • Relapse may be triggered by eating spicy foods, drinking alcoholic beverages, sunlight, stress, or having the intestinal bacteria Helicobacter pylori.
  • There are four subtypes of rosacea that present with a wide variety of face symptoms.
  • Common symptoms include facial flushing, raised, red bumps, facial redness, skin dryness, and skin sensitivity.
Read full article on respiratory syncytial virus (RSV).

Acute respiratory distress

Acute respiratory distress

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This condition is considered a medical emergency. Urgent care may be required.

  • 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 damage to 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, a fast heart rate, and confusion.
Read full article on acute respiratory distress.

Carbon monoxide poisoning

Carbon monoxide poisoning

Image by: Intermedichboderivative work: MagentaGreen [Public domain], via Wikimedia Commons

This condition is considered a medical emergency. Urgent care may be required.

  • Carbon monoxide (CO) is a gas that’s both odorless and colorless and causes your red blood cells to not carry oxygen efficiently.
  • 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, and 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.
Read full article on carbon monoxide poisoning.

Emphysema

Emphysema

Image by: Drazen

  • Emphysema is one of the two most common conditions that fall under the umbrella term chronic obstructive pulmonary disease (COPD).
  • 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.
Read full article on emphysema.

Pneumothorax

Pneumothorax

Image by: Karthik Easvur (Own work) [CC BY-SA 3.0 (creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

This condition is considered a medical emergency. Urgent care may be required.

  • 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, and severe tachycardia.
Read full article on pneumothorax.

Pulmonary embolism

Pulmonary embolism

Image by: Hellerhoff [CC BY-SA 3.0 (creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons

This condition is considered a medical emergency. Urgent care may be required.

  • This type of embolism ccurs 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, and dizziness or fainting.
Read full article on pulmonary embolism.

Cyanosis

Cyanosis

Image by: James Heilman, MD [CC BY-SA 3.0 (creativecommons.org/licenses/by-sa/3.0)], from Wikimedia Commons

This condition is considered a medical emergency. Urgent care may be required.

  • 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 cyanosi.
  • Most causes of cyanosis are serious and a sign that your body isn't getting enough oxygen.
Read full article on cyanosis.

Sickle cell anemia

Sickle cell anemia

Image by: OpenStax College [CC BY 3.0 (creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

  • 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, and episodes of extreme pain in the chest, back, arms, or legs.
Read full article on sickle cell anemia.

Asthma

Asthma

Image by: United States National Institutes of Health: National Heart, Lung, Blood Institute [Public domain], via Wikimedia Commons

  • 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 such as viral illness, exercise, weather changes, allergens, smoke, or strong scents.
  • Symptoms include dry coughing, high-pitched wheezing, tight chest, shortness of breath, and difficulty breathing.
  • Symptoms of asthma may be reduced or resolved by using asthma medications.
Read full article on asthma.

Cardiac tamponade

 Cardiac tamponade

Image by: BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

This condition is considered a medical emergency. Urgent care may be required.

  • 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.
  • Swollen veins in the forehead, low blood pressure, fainting, dizziness, cold, blue extremities, and loss of consciousness are other symptoms.
  • A person with this condition may also experience trouble breathing or taking deep breaths and rapid breathing.

Read full article on cardiac tamponade.

Raynaud’s phenomenon

Raynaud’s phenomenon

Image by: WaltFletcher [CC BY-SA 4.0 (creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

  • 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 such as 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.
Read full article on raynaud’s phenomenon.

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

Lung disease and 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.

In addition, blue lips may be associated with the following conditions:

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

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

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

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 such as 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 such as quitting smoking and starting an exercise regimen that will improve your respiratory and vascular health. Pulmonary rehabilitation may be recommended.

Cyanosis that is 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. However, 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.

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 is causing this symptom.

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