Acrocyanosis spelt out with colorful letters under a stethoscope against a light brown, wood background.
Acrocyanosis is a condition in newborns that causes extremities to turn blue.

What Is Acrocyanosis and How Is It Related to Newborns?

In general, cyanosis refers to the bluish discoloration of the skin and mucus membranes. If blue skin appears only at the extremities, it is called acrocyanosis or peripheral cyanosis. The term acrocyanosis comes from the Greek words “akron”, which means extremity, and “kuaneos”, which means dark blue. The blue color comes from a decrease in blood flow and oxygen delivered to the tissues of the extremities.

Acrocyanosis in a newborn is a common clinical finding. This condition may occur immediately after birth in healthy newborns and may persist for 24 to 48 hours.

The temporary discoloration in newborns is usually painless and often regarded as benign, as long as there is no cyanosis present in the central part of the body. By contrast, central cyanosis is discoloration seen throughout the body and involves the lips and tongue. It is a serious indication of potentially life-threatening diseases. This condition requires immediate evaluation and treatment.

Young children may also have temporary acrocyanosis when they are cold. It usually happens when they are swimming or bathing in cold water and resolves once they warm up.

What Causes Acrocyanosis?

Acrocyanosis is divided into two types: primary and secondary. The cause of acrocyanosis may vary depending on each type.

Primary Acrocyanosis

Acrocyanosis is categorized as primary when there is no identified underlying disorder associated with the condition after proper investigation.

The cause of primary acrocyanosis in newborns is due to the adjustment of the infant's blood circulation. Infants' blood and oxygen prefer to first supply the brain, lungs, kidneys and other important organs of the body, before the hands and feet. This condition should improve once the body of the infant gets used to the new blood circulation pattern.

Secondary Acrocyanosis

In secondary acrocyanosis, there is a specific underlying disease associated with it. The causes usually vary and include infections, vascular diseases, blood disorders, eating disorders, solid tumors, cancer, genetic diseases and some drugs.

One of the most common causes of secondary acrocyanosis is Raynaud's phenomenon. It is a condition where blood flow to fingers, toes, ears, or nose is interrupted. This blood flow restriction results in extremities turning pale, then blue and then red.

Some people with anorexia have acrocyanosis because weight loss can impair body heat regulation. Drugs, such as ergot alkaloids used to treat migraines and severe headaches, can also cause acrocyanosis.

What Are the Symptoms?

The main symptom of acrocyanosis is the hands becoming bluish-purple - although, it happens less frequently with feet. Fingers and toes may also become cold and sweaty.

These symptoms are usually present right after birth and may last in the baby's first few hours. The symptoms may come back when the baby is cold but should be corrected after exposure to a warm environment.

Primary cyanosis is also called idiopathic or essential acrocyanosis. It is harmless and is commonly associated with cold temperature and emotional stress. In primary acrocyanosis, the symptoms are symmetrical. It affects both sides of the body, meaning both hands and both feet.

On the other hand, secondary acrocyanosis can be serious, depending on the underlying disease. It is usually painful and may involve tissue loss. The symptoms affect only one side of the body.

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How Is Acrocyanosis Diagnosed?

Your doctor will perform a physical exam, they’ll take a medical history and assess the symptoms to diagnose if your baby has acrocyanosis.

Primary acrocyanosis in a newborn is diagnosed based on the hands and feet being bluish, cold and sweaty. When it is not painful, it is usually not associated with a disease of impaired circulation.

The doctor may use a non-invasive diagnostic technique called capillaroscopy to measure the circulation in the small blood vessels like those at the nailbeds.

Other tests and imaging procedures may be performed to rule out other conditions, including Raynaud's syndrome. These tests are necessary to determine underlying diseases, especially if secondary acrocyanosis is suspected.

How Is It Treated?

There is no standard medical treatment for acrocyanosis in a newborn. Medicines may not be necessary in mild cases. Sometimes, changes in lifestyle, diet, hygiene and avoidance of cool environments are sufficient methods to improve the condition.

With newborns and infants, warming them is the most effective treatment for primary acrocyanosis. The reassurance of the doctor that the bluish discoloration does not indicate any serious illness is very important.

Since primary acrocyanosis is considered a benign condition, doctors will only prescribe conservative and non-toxic therapies. People with primary acrocyanosis may receive biofeedback training in physical therapy clinics, medical centers and hospitals. Conditioning of reflexes and hypnosis may also give partial relief.

In severe cases, doctors may prescribe certain medications to ease symptoms:

  • Alpha-blockers
  • Calcium channel blockers
  • Topical nicotinic acid derivatives
  • Minoxidil

For secondary acrocyanosis in a newborn, the underlying diseases are managed and treated to improve the symptoms of acrocyanosis.

Talk to Your Doctor

It is always best to consult the doctor if you notice symptoms of acrocyanosis to determine if it is harmful. That way, you will know the best treatment option will be available to avoid possible complications.