Blueness of the Lips or Fingernail Beds

Reviewed by: HU Medical Review Board | Last reviewed: December 2023

People with chronic obstructive pulmonary disorder (COPD) can have blueness of the lips or fingernail beds. This occurs due to a lack of oxygen in the blood, impairing the body’s ability to function normally.1-3

What is cyanosis?

People with COPD experience a variety of complications, including heart and lung diseases. People may notice parts of the body or skin start to turn a different color. The medical term for this is cyanosis.1-3

Cyanosis causes a person’s skin, lips, or fingernails to turn to a blue or bluish color. The color can also look bluish-gray or dark purple.1-3

Types of cyanosis include:1

  • Perioral cyanosis – affects the lips and mouth
  • Peripheral cyanosis – occurs in the arms, legs, feet, hands, and fingernail beds
  • Central cyanosis – involves your hands and feet, along with the chest, cheeks, tongue, and lips

What causes cyanosis?

Normal blood flow helps keep a person’s skin color natural or pink. COPD restricts blood flow and circulation, impacting the skin’s natural coloration. COPD can also affect the amount of oxygen in the blood. Changes in skin color are a sign that there is a lack of oxygen in the blood.1-3

Red blood cells carry oxygen from the lungs to the tissues in your body. The red blood cells absorb oxygen from the air we breathe in through our lungs. These blood cells are a bright red color when they are rich in oxygen. In turn, this causes our skin to look healthy.1-3

Blood cells that change from bright red to a darker bluish color indicate a lack of oxygen. This causes the person to develop a blueness of the skin, lips, or fingernail beds.1-3

How common is cyanosis with COPD?

Cyanosis usually develops slowly over time. It depends on the level of oxygen in the blood and how quickly it decreases. The bluish tint can be hard to notice at first. Many people with COPD may not know that the amount of oxygen in their blood is getting too low.3,4

A sudden onset of cyanosis may mean a person is having an acute COPD attack or flare-up. People having a COPD attack should contact their doctor for advice on how to manage it or reduce symptoms.3,4

Chronic cyanosis is more common among people with later-stage COPD. This means their skin stays a bluish color or it happens more often. Doing exercise or being active might make this bluish color worse.3,4

Symptoms and complications of cyanosis

Cyanosis usually happens when oxygen levels in the blood are very low. The parts of the body most affected by cyanosis can help determine the cause. Cyanosis may be related to your lungs, heart, or central nervous system.1

Other symptoms include:1-4

  • Numbness or tingling in your arms and legs
  • Coughing
  • Wheezing
  • Shortness of breath
  • Dizziness
  • Extreme tiredness (fatigue)
  • Weakness

Reduced oxygen in people with COPD can be caused by:1,5

  • Lung damage that prevents blood cells from absorbing enough oxygen
  • Restricted blood flow due to high blood pressure and pulmonary hypertension
  • Chronic bronchitis, emphysema, or pneumonia
  • Congestive heart failure
  • Inflammation in the respiratory tract
  • Other complications from COPD

People with COPD often have other conditions. Pulmonary hypertension (high blood pressure in the blood vessels in the lungs) often occurs along with COPD. Cyanosis is also one of the symptoms of pulmonary hypertension.5

How is cyanosis diagnosed?

Cyanosis is diagnosed based on a person’s health history, physical examination, and other tests. An ultrasound of the heart (echocardiogram) can be used to check the cardiovascular system.1,3-5

Questions a doctor may ask include:

  • When did you first notice changes in your skin color?
  • Did the cyanosis appear suddenly or slowly?
  • Are you having trouble breathing?
  • What parts of your body are blue?
  • Are your arms or legs swelling?
  • What other symptoms and conditions do you have?

Tests used to diagnose cyanosis include:1,2

  • Pulse oximetry – measures the amount of oxygen in your blood
  • Arterial blood gas analysis – measures the amount of oxygen in your arteries
  • Chest X-ray or CT scan
  • Complete blood count (CBC)
  • Electrocardiogram (EKG) or echocardiogram of the heart
  • Pulmonary function tests

How is cyanosis treated?

Cyanosis can be related to many different conditions. The treatment depends upon:1,2

  • The cause and severity of the cyanosis
  • How low blood oxygen levels have become

If COPD itself is causing cyanosis, doctors may use oxygen therapy or a breathing machine (ventilator) to deliver extra oxygen into the lungs. Drug therapy may be used to treat COPD or the complication that is causing the cyanosis.1,2

Other possible treatments include:1,3,5

  • Warmth and massage
  • Antibiotics to treat other infections
  • Medicines to treat heart and lung conditions
  • Stopping medicines that restrict blood flow
  • Lifestyle changes like quitting smoking

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