1141
Refers to blue or cyanotic discoloration of the extremities, most commonly occurring in the hands, although it also occurs in the feet and distal parts of face.
It is characterized by peripheral cyanosis: persistent cyanosis of the hands or of the hands, feet, or face.
The principal form is that of a benign cosmetic condition, sometimes caused by a relatively benign neurohormonal disorder.
The benign form typically does not require medical treatment.
If the extremities experience prolonged periods of exposure to the cold, particularly in children and patients with poor general health, acrocyanosis can lead to an medical emergency.
Frostbite differs from acrocyanosis because pain often accompanies it.
Other conditions that affect hands, feet, and parts of the face with skin color changes that need to be differentiated from acrocyanosis: Raynaud’s phenomenon, pernio, acrorygosis, erythromelalgia, blue finger syndrome.
It may be a sign of a serious medical problem, such as connective tissue diseases and diseases associated with central cyanosis, infections, toxicities, antiphospholipid syndrome, cryoglobulinemia, and neoplasms.
Cutaneous changes due to the above processes are known as secondary acrocyanosis.
Secondary acrocyanosis may be less symmetric distribution and may be associated with pain and tissue loss.
With acrocyanosis extremities often are cold and clammy, may exhibit some swelling, and the palms and soles exhibit a wide range of sweating from moderately moist to profuse.
All peripheral pulses are of normal rate, rhythm, and quality.
Exposure to cold temperatures worsens the cyanosis.
Warming often improves cyanosis.
Patients normally are asymptomatic and therefore there is usually no associated pain.
Discoloration is usually is what prompts medical care.
Precise mechanism is not known.
Suggestions vasospasms in the cutaneous arteries and arterioles produce cyanotic discoloration, while compensatory dilatation in the postcapillary venules causes sweating.
Shunting also occurs in the arteriovenous subpapllary plexus, and persistent vasoconstriction at the precapillary sphincter creates a local hypoxic environment, thus releasing adenosine into the capillary bed.
Adenosine then enters the capillary bed, where it vasodilates the postcapillary venules.
Other hormones may contribute to acrocyanosis such as increase blood levels of serotonin.
Acrocyanosis has been reported in association with SSIRs and other medications.
Diagnosis is based on a medical history and physical examination.
The use of laboratory studies or imaging studies is not necessary.
Normal peripheral pulses are present and pulse oximetry will show a normal oxygen saturation.
There is usually no associated trophic skin changes, localized pain, or ulcerations.
Unlike Raynaud’s phenomenon, cyanosis is continually persistent.
There is no standard treatment for acrocyanosis, but the patient is reassured that no serious illness is present.
A sympathectomy could alleviate the cyanosis by disrupting the fibers of the sympathetic nervous system to the area, but such an extreme procedure would rarely be appropriate.
Prognosis is excellent, as there is no associated increased risk of disease or death, and there are no known complications.
There is no definitive reporting on its incidence.
Shows a greater prevalence in children and young adults than in patients thirty years of age or older.
A cold climate, outdoor occupation, and low body mass index are significant risk factors its development.
It is more prevalent in women than in men due to differences in BMI.
Incidence rate often decreases with increasing age.
Resolves in many women after menopause implying significant hormonal influences.
It is common initially after delivery of a newborn.
Intervention normally is not required, although supplemental oxygen for precautionary measures is usually applied.