Skin Discoloration
June 24, 2008
Skin discoloration results from several factors. Some are natural, such as birthmarks. Others are related to factors such as sun exposure (e.g., disseminated superficial actinic porokeratosis, hyperpigmentation) or allergy or immune reaction (lichen planus). The skin can become darker (e.g., acanthosis nigricans, progressive pigmentary purpura) or lighter (albinism, vitiligo).
Skin coloration is determined by the amount of pigment in the skin and the blood flowing through it. Blood that is saturated with oxygen is bright red. Blood that has lost its oxygen is dark bluish-red. People whose blood is deficient in oxygen tend to have a bluish discoloration to their skin called cyanosis.
Lack of oxygen (such as in suffocation or cyanotic heart disease), abnormal hemoglobin (such as methemoglobinemia) and toxins (such as cyanide) can all produce cyanosis. Most cyanosis occurs as a result of heart disease (such as congestive heart failure), lung disease, or as a terminal event such as cardiopulmonary arrest.
Mild cyanosis is difficult to detect. A person’s bloodstream needs to contain a significant amount of hemoglobin without oxygen for a doctor to see cyanosis. Usually the oxygen saturation of the blood has to drop below 90% before this occurs.
Cyanosis is more obvious in the mucous membranes and nail beds, particularly in dark-skinned people. It may also appear on the feet, nose, and ears.
Many people get brief, bluish-purplish, painful color changes in their fingers (called Reynaud’s syndrome) resulting from a spasm of blood vessels in the hands, often in response to the cold. Some people with Reynaud’s syndrome also have a collagen-vascular disease called scleroderma.
Major causes of skin discoloration are:
Brief exposure to cold air or water
High altitudes
Chronic obstructive pulmonary disease (COPD)
Pneumonia, severe
Pulmonary edema
Congestive heart failure
Pulmonary hypertension
Shock
Hyaline membrane disease associated with prematurity
Aspiration with suffocation
Breath-holding
Bronchiolitis
Congenital heart disease
Croup
Epiglottitis
Asthma
Seizures
Drug overdoses (narcotics, benzodiazepines, sedatives)
Drowning or near-drowning.
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