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Acrocyanosis … A Rare Condition of the Extremities

Acrocyanosis of the feet
Acrocyanosis of the feet

What Is It?

Acrocyanosis is a vascular disorder of the peripheral system, characterised by bluish discolouration of the skin and mucous membranes. This bluish colour comes from a loss of oxygen in the blood. This condition normally affects the extremities (the hands and feet), and can be extremely painful, or not painful at all. Acrocyanosis is not a common condition, and symptoms can develop after exposure to cold weather, or may persist all the time.

What Causes It?

A baby with Acrocyanosis
A baby with Acrocyanosis

This disorder may be caused by a number of reasons, but two are most commonly to blame. Firstly, a person may have cardiac (heart) or pulmonary (lung) abnormalities, affecting the amount of oxygen that is carried throughout the body. Secondly, a person may have localised tissue deoxygenation problems. Acrocyanosis is most commonly found in children and young adults under the age of 30, and variables such as body weight, occupation, and climate can affect its prevalence. It is more commonly reported in females, people with neurological deficits, and people with emotional or mental disorders.

There are two forms of the condition, primary and secondary. Primary acrocyanosis occurs by itself, apart from any other condition, while secondary acrocyanosis is associated with a more serious condition, such as a connective tissue disorder.

Symptoms

Typically symmetrical, it is marked by a mottled blue or red discolouration of the skin on the fingers, wrists, toes and ankles. Profuse sweating and coldness of the fingers and toes may also occur. Considered a vasospastic disorder, it affects the arteries supplying blood to the skin of the hands and feet. It is caused by narrowing (constriction), of small arterioles (tiny arteries), toward the end of the arms and legs.

Vasospasm refers to the arteries going into spasm and blocking the flow of blood. These small arteries carry the oxygen, along with nutrients, through the blood to the skin of the hands and feet. When the blood cannot flow through, the skin will lack the necessary oxygen required, and then turn a dark blue to purple colour. This characteristic colour is called cyanosis, hence the name acrocyanosis.

Vasospasm is also seen in Raynaud’s disease, and may last several minutes to several hours. However, the vasospasm in acrocyanosis is more persistent. In addition, the vasospasm in Raynaud’s disease affects the small arteries supplying blood to the fingers and toes. In acrocyanosis, the vasospasm affects the arteries supplying blood flow to the skin of the hands and or feet. Therefore the skin damage and ulcerations seen in Raynaud’s disease are not present in acrocyanosis. Lastly, Raynaud’s disease goes through a typical triphasic or biphasic colour change. In contrast, acrocyanosis maintains its characteristic blue skin colouration.

Diagnosis

Typical symptoms and signs of acrocyanosis of the hands or feet are a persistently cold temperature and the blue discolouration. They often feel sweaty or moist, and swelling may be present. The cyanosis usually appears worse upon exposure to cold, and improves upon warming. Rarely is there any associated pain. Normal arterial pulses are always present in the hands and feet, since there is no blockage of the larger arteries of the arms or legs.

Treatment 

Insulated boots to prevent Acrocyanosis
Insulated boots to prevent Acrocyanosis
Liner Socks to help with Arcocyanosis
Liner Socks to help with Arcocyanosis

Generally, the treatment is a common sense approach to preventing cold exposure and keeping the feet dry. This may involve the use of insulated boots; thin polypropylene liner socks to wick the moisture away from the skin; and an insulated sock to maintain normal skin temperature. Usually, no other treatment is necessary. Vasodilators have been tried with limited success. In extreme cases, a surgical procedure called a sympathectomy has been performed to relax the persistent vasospasm. This surgery is rarely necessary, and seldom recommended.

                                                       

   Your feet mirror your general health . . . cherish them!

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