Top 5 Causes of Blue Skin
Blue skin questionnaire
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What is blue skin?
Blue skin often means there’s an issue with the flow of your blood or oxygen supply. The most common cause is a bruise. When tiny blood vessels are injured, blood collects beneath the skin, causing the blue color.
Or you may get blue hands after spending time outside in cold weather. Blood vessels constrict in the cold, so less blood reaches your fingertips and toes, turning them blue.
Blue skin can be a sign that the heart and lungs aren’t working as well as they should. If your heart and lungs struggle to send enough oxygen to your body, the low-oxygen blood has a blue color and is visible in areas of the body with thin skin.
If you’re not getting enough oxygen circulating in your blood, you may see blue lips, hands, fingers, or toes. If you also have breathing problems, chest pain, fever, confusion, or fatigue, it can be a sign of a more serious problem called “cyanosis.”
Conditions that can cause low oxygen include chronic obstructive pulmonary disease (COPD) and congestive heart failure.
You should always see a doctor when you have unexplained blue skin.
1. Raynaud’s syndrome
- Very cold hands and feet when exposed to the cold (even a minor exposure like opening the fridge)
- Blue or pale hands and feet after cold exposure
- Pins and needles sensation in hands and feet
When you get cold, your blood vessels constrict, or become narrower, which decreases blood flow and the oxygen supply to your extremities. In people with Raynaud’s syndrome, tiny blood vessels overreact, completely stopping oxygen flow to the skin. The phenomenon is uncomfortable but not serious. Your skin will return to normal once you warm your hands.
Some people take medication to dilate (relax) blood vessels. If your symptoms don’t improve after your hands or feet warm up, you may need emergency treatment.
2. Chronic obstructive pulmonary disease
A big part of my job is determining whether a patient is very sick or probably not very sick. When a patient reports blue skin, I’m going to be making observations as soon as I walk through the door. If the patient says, “I have blue skin and I can’t catch my breath,” or “I have blue skin and it feels like an elephant is sitting on my chest,” I’m jumping into action to help the patient feel better and try to quickly figure out the cause. —Dr. Anne Jacobsen
- Shortness of breath
- Cough, often producing phlegm, but could be dry
- Blue skin
Chronic obstructive pulmonary disease (COPD) is a lung disease that is chronic, meaning that it can worsen over time. COPD includes both emphysema and chronic bronchitis. Emphysema is when the air sacs in the lungs are destroyed. Chronic bronchitis is caused by inflammation and thickening of the lining of the airways. People with chronic bronchitis also have excessive mucus in their airways.
These chronic symptoms can worsen with a respiratory infection like a cold or flu. Or from exposure to smoke or polluted air. When this happens, it can cause a dip in oxygen levels, which may lead to blue skin.
Both conditions can cause difficulty with breathing and a chronic cough. The biggest risk factor for COPD is cigarette smoke exposure, but some people develop COPD due to longtime exposure to workplace chemicals.
A doctor can diagnose COPD with a breathing test called a pulmonary function test. Although there is no cure for COPD, treatments can reduce symptoms and make it easier to breathe.
People with COPD should stop smoking right away. They may use inhalers daily or as needed to help open the airways. Steroid medications can be taken by mouth when symptoms flare. Some people with more severe symptoms need to use a portable oxygen tank to keep their oxygen levels in a healthy range.
3. Peripheral artery disease
- Leg pain or cramping that may worsen with exercise
- Cool feet
- Weak pulses in feet
- Numbness or tingling in feet
- Blue skin
Peripheral artery disease (PAD) occurs when arteries outside the heart, particularly in the legs, become narrowed. Occasionally, arteries can become completely blocked and blood can’t reach its destination.
If you notice your feet or hands turning blue or if they become cold to the touch, it may mean the artery is completely blocked. This is a medical emergency and you should go to the ER.
PAD develops gradually. You may notice tingling or numbness in your legs only when you exercise or move.
PAD is diagnosed by comparing the ankle blood pressure to the arm blood pressure. A doppler ultrasound uses sound waves to check the pulses in your arms or legs. You may have an angiogram, which is a type of X-ray after receiving a dye injection.
Treatment includes quitting smoking, exercising, and eating healthy food. In severe cases, emergency surgery may be necessary to restore blood flow.
4. Congestive heart failure
Congestive heart failure (CHF) occurs when your heart can no longer effectively pump blood for your body to function normally. This causes problems with oxygen delivery to the rest of the body, and fluid builds up in the lungs and lower legs.
CHF is diagnosed with echocardiography—an ultrasound of the heart. This detects how much blood in the left side of the heart is pumped out with each heartbeat. Other tests include blood work, chest X-ray, and an EKG.
Depending on the degree of CHF, you may need to make lifestyle modifications, take medications, or undergo surgery. Lifestyle modifications include
- Quitting smoking.
- Eating a healthy diet.
- Limiting fluid intake.
- Monitoring your weight.
You may need to take a medication to control blood pressure, and many people take a diuretic, sometimes referred to as a “water pill.” This helps get rid of excess fluid in your urine. You may need to take blood thinners. Some people may need a minor surgery to place an automated implantable cardioverter defibrillator (AICD) that can give a shock to your heart if a life-threatening abnormal heart rhythm is detected.
- Shortness of breath
- Cough that produces phlegm
- Blue skin
Pneumonia is a lung infection that can be caused by bacteria, viruses, or fungi. Illnesses caused by viruses, such as the flu, can develop into pneumonia. Pneumonia can be a medical emergency for very young children or people over age 65. This also applies to people with weakened immune systems or chronic heart or lung conditions.
Pneumonia is diagnosed with a chest X-ray. Blood tests may provide more information. Treatment depends on the type of pneumonia you have. Bacterial pneumonia must be treated with antibiotics. Hospitalization may be necessary.
6. Pulmonary embolism
A pulmonary embolism (PE) occurs when a blood clot travels from the veins of the legs and causes a blockage of the arteries of the lungs. Your risk increases if you have been sedentary (not moving around, especially from travel or surgery), have a blood disorder that makes your blood more likely to clot, or have or had a leg injury.
This condition is usually diagnosed with a special CT scan after a dye injection. You may also need blood tests, an EKG, and a chest X-ray. An ultrasound of the leg can show a blood clot that might move to the lungs.
You will be given blood thinners to prevent the clot from getting bigger. Some people need surgery to remove the clot. Some might need a special filter placed in a blood vessel near the heart to catch clots before they reach the lungs.
Other possible causes
Many doctors have used rubbing alcohol to cure blue skin! If the blue color comes off with an alcohol wipe, the diagnosis is confirmed. We love to give patients good news, so this situation is a happy one for both parties. If you notice blue skin and you otherwise feel fine, quickly try to remember whether you might have been wearing new blue jeans or doing an art project! —Dr. Jacobsen
There are a number of other less common causes of blue skin. Clothing or jewelry that fit too tightly could limit blood flow and oxygen to your fingers or toes and cause blue discoloration. Dyes, including fabric dyes in new clothing, can transfer onto your skin and give it a blue appearance. Certain medications can cause blue pigmentation of the skin. Extreme cold and high altitude can also cause blue skin, but skin should return to normal with warming or going to a lower altitude.
When to call the doctor
- Blue skin does not go away but you otherwise feel okay
- Persistent coughing
Should I go to the ER for blue skin?
You should go to the ER if your blue skin is accompanied by any of the following symptoms, which may be a sign of a more serious problem:
- Difficulty breathing or wheezing
- Chest pain
- Fever (greater than 100.4°F)
- Blue skin that starts to turn black
- Blue skin around your lips or inside your mouth
- Headache, confusion, or dizziness
- Foot that is painful and cool to the touch, or with numbness or tingling
Ask your doctor what you can do to prevent this symptom in the future. Some of the conditions that cause blue skin are chronic, meaning that they don’t go away completely even with treatment, but they can be managed with lifestyle modifications, prescription medications, or both. —Dr. Jacobsen
- Check if any of your medications could cause blue skin.
- Avoid extreme cold and wear proper cold-weather gear.
- Try to warm up if you have been out in the cold.
- Monitor blue skin to see if it gets better, stays the same, or worsens.
- If you think it’s from fabric dye, try to remove with rubbing alcohol.
Other treatment options
- Lifestyle modification
- Medication management
Dr. Jacobsen is a board-certified Emergency Medicine physician and writer for Buoy Health. She received her undergraduate degrees in Chemistry and Biology from Macalester College (2006) and graduated from the University of Kansas School of Medicine (2010). She completed an Emergency Medicine residency program at the University of Missouri-Kansas City (2013). She practices community Emergency Medicine in Kansas City and is also engaged in urgent care telemedicine. She joined Buoy Health in 2021. She is passionate about explaining medicine in terms that patients can understand. She hopes to empower her patients with great educational resources so they can understand their current medical concerns and improve their health for the future.