Acrocyanosis: Description, Causes and Risk Factors:Acrocyanosis is a painless disorder that affects the arteries supplying blood to the skin of the hands and feet. These small arteries carry oxygen and nutrients through the blood to the skin of the extremities. Spasms in the arteries block blood flow in people with this condition. Without adequate blood supply, the skin lacks oxygen, which changes the skin color to a dark blue to purple color. This characteristic color is called cyanosis.Acrocyanosis is generally a benign condition, but can be indicative of a serious medical illness elsewhere in the body, such as cardiovascular or connective tissue disease. It occurs more frequently in women than in men.Unlike the vasospasm seen in Raynaud's disease which may last several minutes to several hours, 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 color change. In contrast, acrocyanosis maintains its characteristic blue skin coloration.Acrocyanosis occurs due to decrease in the amount of oxygen delivered to the extremities. The exact etiology is unknown. Peripheral arterial vasoconstriction due to increased tone of the arterioles associated with secondary vasodilatation of capillaries and subpapillary venous plexus has been postulated. The cause of the disordered vascular tone is unknown. Changes of blood viscosity have been reported.Acrocyanosis may be a sign of a more serious medical problem, such as connective tissue diseases (CTD) and diseases associated with central cyanosis. Other causative conditions include infections, toxicities, antiphospholipid syndrome, cryoglobulinemia, neoplasms. In these cases, the observed cutaneous changes are known as "secondary acrocyanosis." They may have a less symmetric distribution and may be associated with pain and tissue loss.Symptoms:Typical symptoms and signs of acrocyanosis of the hands or feet are persistently cold temperature and blue discoloration. They often feel sweaty or moist, and swelling may be present. The blue cyanosis usually appears worse upon exposure to cold, and improves upon warming. Rarely is there any pain associated. 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.Diagnosis:Acrocyanosis is diagnosed clinically, based on a medical history and physical examination. The normal peripheral pulses rule out peripheral arterial occlusive disease, where arterial narrowing limits blood flow to the extremities. Pulse oximetry will show normal oxygen saturation. Unlike the closely related Raynaud's phenomenon, cyanosis is continually persistent. In addition, there is usually no associated trophic skin changes, localized pain, or ulcerations.Capillaroscopy and other laboratory methods may be helpful but only complement clinical diagnosis in unclear cases, especially when they connective tissue disorders may be present. Imaging and laboratory testing are mandatory only in extremely severe cases.Treatment: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. Generally no other treatment is necessary. In extreme cases a surgical procedure called a sympathectomy required to relax the persistent vasospasm. This surgery is recommended only in severe cases.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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