A bluish color to the skin or mucous membrane is usually due to a lack of oxygen in the blood. The medical term is cyanosis.
Red blood cells provide oxygen to body tissues. Most of the time, nearly all red blood cells in the arteries carry a full supply of oxygen. These blood cells are bright red and the skin is pinkish or red.
Blood that has lost its oxygen is dark bluish-red. People whose blood is low in oxygen tend to have a bluish color to their skin. This condition is called cyanosis.
Depending on the cause, cyanosis may develop suddenly, along with shortness of breath and other symptoms.
Cyanosis that is caused by long-term heart or lung problems may develop slowly. Symptoms may be present, but are often not severe.
When the oxygen level has dropped only a small amount, cyanosis may be hard to detect.
In dark-skinned people, cyanosis may be easier to see in the mucous membranes (lips, gums, around the eyes) and nailbeds.
People with cyanosis do not normally have
(low blood count). Anemia is a condition in which the body does not have enough healthy red blood cells.
Cyanosis that is seen in only one part of the body may be due to:
A
that blocks the blood supply to a leg, foot, hand, or arm
(condition in which cold temperatures or strong emotions cause blood vessel spasms, which block blood flow to the fingers, toes, ears, and nose)
Most often, cyanosis occurs because of a lack of oxygen in the blood. This can be caused by the following problems.
Problems with the lungs:
Blood clot in the arteries of the lungs (
)
Drowning or
High altitude
Infection in the smallest air passages in the lungs of children, called
Long-term lung problems that become more severe, such as
chronic obstructive pulmonary disease
(COPD),
, and
(severe)
Problems with the airways leading to the lungs:
Breath-holding (although this is exceedingly difficult to do)
Choking on something stuck in the airways
Swelling around the vocal cords (
)
Inflammation of the flap of tissue, called the epiglottis, that covers the windpipe (
)
Problems with the heart:
Heart defects that are present at birth (congenital)
Heart stops working (
)
Other problems:
Drug overdose (narcotics, benzodiazepines, sedatives)
Exposure to cold air or water
Seizure that lasts a long time
Toxins such as cyanide
For cyanosis caused by exposure to cold or Raynaud phenomenon, dress warmly when going outside or stay in a well-heated room.
Most other acute episodes of cyanosis need to be diagnosed and treated by a health care provider (office or emergency room).
Bluish skin can be a sign of many serious medical problems. Contact or visit your provider.
For adults, contact your provider or call the local emergency number, such as 911 if you have bluish skin and any of the following:
Cannot get a deep breath or your breathing is getting harder, or faster
Need to lean forward when sitting to breathe
Are using muscles around the ribs to get enough air
Have chest pain
Are having headaches more often than usual
Feel sleepy or confused
Have a fever
Are coughing up dark mucus
Are unable to speak a full sentence because of shortness of breath
For children, contact your provider or call 911 or the local emergency number if your child has bluish skin and any of the following:
Hard time breathing
Moving chest muscles in with each breath
Breathing faster than 50 to 60 breaths per minute (when not crying)
Making a grunting noise
Sitting with shoulders hunched over
Is very tired
Moving very little
Has a limp or floppy body
Nostrils flare out when breathing
Does not feel like eating
Is irritable
Has trouble sleeping
In general, cyanosis that occurs acutely is more likely to be an emergency than when it is present for a long time.
Your provider will perform a physical exam. This will include listening to your breathing and heart sounds. In emergency situations (such as
), you will be stabilized first.
Your provider will ask about your symptoms. Questions may include:
When did the bluish skin develop? Did it begin slowly or suddenly?
Is your body blue all over? How about your lips or nailbeds?
Have you been exposed to cold or have you been at a high altitude?
Do you have
? Do you have a cough or chest pain?
Do you have
?
Tests that may be ordered include:
Blood oxygen saturation by pulse oximetry
(CBC)
(ECG)
(ultrasound of the heart)
The treatment you receive depends on the cause of cyanosis. For example, you may receive oxygen for shortness of breath.
Lips - bluish; Fingernails - bluish; Cyanosis; Bluish lips and fingernails; Bluish skin
McGee S. Cyanosis. In: McGee S, ed. Evidence-Based Physical Diagnosis. 5th ed. Philadelphia, PA: Elsevier; 2022:chap 9.
Shetty P, Fernández-Frackelton M. Cyanosis. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 10.
Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.