What causes acrocyanosis (blue discoloration of extremities) or peripheral cyanosis (blue discoloration of toes and fingers)?

From the Guidelines

Purple toes and fingers are primarily caused by poor blood circulation, often resulting from peripheral artery disease, as indicated by the 2018 European Society of Cardiology guidelines 1. This condition can lead to reduced blood flow to the limbs, resulting in tissue loss and increased risk of amputation if left untreated. The guidelines emphasize the importance of regular clinical examination, especially in elderly and diabetic patients, to recognize tissue loss and refer to a vascular specialist for limb salvage 1. Key factors to consider in the diagnosis of poor blood circulation include:

• Clinical stages of lower extremity artery disease, such as arterial ulcers and pain absence, which may indicate peripheral neuropathy 1
• Investigation of the microcirculation, including transcutaneous oxygen pressure (TcPO2), to assess tissue oxygenation 1
• Ankle pressure <50 mmHg or toe pressure <30 mmHg, which are often associated with chronic limb-threatening ischemia (CLTI) 1 Other potential causes of purple toes and fingers may include Raynaud's phenomenon, acrocyanosis, and certain medications, but peripheral artery disease is a primary concern due to its association with increased risk of cardiovascular morbidity and mortality 1. Treatment of the underlying cause is crucial, and seeking medical attention promptly is essential if symptoms such as pain, numbness, or skin changes occur.

From the Research

Causes of Purple Toes and Fingers

There are several potential causes of purple toes and fingers, including:

• Poor circulation: Reduced blood flow to the extremities can cause discoloration, as seen in conditions such as Raynaud's phenomenon 2
• Medication side effects: Certain medications, such as beta-blockers, can cause peripheral vasoconstriction, leading to decreased blood flow to the extremities 3, 4, 5, 6
• Cardiovascular disease: Conditions such as hypertension, heart failure, and ischemic heart disease can increase the risk of poor circulation and subsequent discoloration 3, 4, 5, 6
• Other medical conditions: Certain medical conditions, such as atherosclerosis and peripheral vascular disease, can also cause poor circulation and discoloration 2

Specific Conditions

Some specific conditions that can cause purple toes and fingers include:

• Raynaud's phenomenon: A condition characterized by vasospasm of the blood vessels in response to cold or stress, leading to decreased blood flow to the extremities 2
• Peripheral vascular disease: A condition characterized by narrowing or blockage of the blood vessels in the extremities, leading to decreased blood flow 2, 5
• Hypertension: High blood pressure can increase the risk of poor circulation and subsequent discoloration 2, 3, 4, 6

Medication-Related Causes

Certain medications can cause purple toes and fingers as a side effect, including:

• Beta-blockers: Medications that can cause peripheral vasoconstriction, leading to decreased blood flow to the extremities 3, 4, 5, 6
• Calcium channel blockers: Medications that can cause vasodilation, but may also have variable effects on blood flow to the extremities 2