Acrocyanosis – A Symptom with Many Facettes

Wollina, Uwe; Koch, Andrè; Langner, Dana; Hansel, Gesina; Heinig, Birgit; Lotti, Torello; Tchernev, Georgi

doi:10.3889/oamjms.2018.035

Cited by 16 publications

(6 citation statements)

References 36 publications

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“…Acrocyanosis is permanent and painless. It presents with chronic coolness and violaceous discoloration of extremities [39]. Erythromelalgia evolves in paroxystic crisis and is characterized by the triad of burning pain, recurrent redness and warmth of the extremities [40,41].…”

Section: Minor Criteriamentioning

confidence: 99%

Chilblains

Nyssen

Benhadou

Magnée

et al. 2020

Vasa

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Summary: Idiopathic chilblain is a relatively common yet poorly recognized acrosyndrome. This literature review aims to better understand and draw attention to this disorder. Chilblain is a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather. It usually resolves spontaneously. The etiology is uncertain, but vasospasm seems to play a role in this abnormal reaction to cold. Diagnosis is most often based on clinical presentation, but a skin biopsy can be useful in dubious cases. In histology, dermal edema and an inflammatory infiltrate are usually present. A distribution of the infiltrate particularly around the eccrine gland is typical. Systemic symptoms and underlying autoimmune disease should be screened. Avoiding cold and keeping extremities warm is the first recommendation for management, as well as smoking cessation. Calcium channel blockers (in particular nifedipine) seems to be the treatment that has been most evaluated in chilblains. However, their effectiveness is not confirmed by all studies. Topical betamethasone is often used but its effect has not been confirmed by randomized clinical trials. Other treatments, such as pentoxifylline, hydrochloroquine and topical nitroglycerin have shown positive effects only in a reduced number of patients. Acupuncture seems to bring a benefit.

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Section: Minor Criteriamentioning

confidence: 99%

Chilblains

Nyssen

Benhadou

Magnée

et al. 2020

Vasa

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“…Acrocyanosis and skin cool to touch had high specificity values. Acrocyanosis and cyanotic nail beds are events of peripheral cyanosis, defined as a blue-purple coloration of the body's extremities (29) . While acrocyanosis occurs in the hands, feet, and ears, cyanosis occurs in the toenails and nail beds of the hands, which may indicate hypoxia (9) .…”

Section: Discussionmentioning

confidence: 99%

“…Cyanosis occurs due to an increase in reduced hemoglobin in capillary blood beyond 5 g% (the normal is around 2.6 g%), not being noticeable until blood oxygen saturation is below 85% (29) . Peripheral cyanosis signals a decrease in blood flow to the extremities (fingers and toes and earlobes), as in vasoconstriction, due to exposure to cold, not necessarily indicating a systemic response (30) .…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis

et al. 2022

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Objective: to analyze the accuracy of the defining characteristics of hypothermia in patients on hemodialysis. Methods: a diagnostic accuracy study was assembled within a cross-sectional study with 124 patients from two dialysis centers. A latent class model was used for data analysis. Results: the nursing diagnosis hypothermia was present in 13 (10.48%) study participants. The most prevalent defining characteristics were hypoxia (100%), decrease in blood glucose level (83.1%), hypertension (65.3%), piloerection (45.2%), and skin cool to touch (41.1%). The defining characteristics acrocyanosis (99.96%) and cyanotic nail beds (99.98%) had a high sensitivity. Acrocyanosis (91.8%), skin cool to touch (64.8%), and peripheral vasoconstriction (91.8%) had high specificity. Conclusion: specific and sensitive indicators of hypothermia work as good clinical indicators for confirming this diagnosis in patients on hemodialysis. The study findings can assist nurses in their clinical reasoning for a correct inference of hypothermia.

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“…Depending on the degree of ischemia, patients' complaints vary from numbness, "pins and needles" sensation, and pain, to actual ulceration and gangrene, typically with secondary Raynaud's. [1][2][3] The alpha-2 adrenergic receptors present in the medial layer of the digital arterioles are the end target of the sympathetic nervous system control of digital blood flow. These receptors play a pivotal role in the development of the 1 afro mentioned pathologies, being upregulated-either absolutely or relatively-causing vasoconstriction and diminished blood supply.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of periarterial sympathectomy in patients with digital ischemia

et al. 2021

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Introduction Digital ischemia with subsequent severe pain and tissue loss is often difficult to treat, with no obvious guidelines or strong evidence in the literature to support a specific treatment modality. Patients who fail medical treatment remain with very limited surgical options due to the difficulty of any intervention in this “no man’s land” area of the hand, as described since 1918. Extended distal periarterial sympathectomy is reported as an effective treatment option since the eighties of last century. The procedure entails large incisions and major technical difficulties. In this study, we describe a less invasive approach with very promising results and equally high success rates. Materials and Methods This was a prospective study. All patients with severe digital ischemia manifesting with bluish discoloration, ulceration, and/or dry gangrene who failed medical treatment underwent distal periarterial sympathectomy for the radial and ulnar arteries, with added digital sympathectomy in very severe cases. Primary endpoints were ulcer healing and improvement in pain scores assessed by Visual Analog Scale pain scoring system. Secondary endpoints included complications and amputation rates. Results This study recruited 17 patients between January 2019 and January 2020. The mean follow-up was 14.6 months. The mean age was 33.71 (±SD 13.14) years. 41% were males. 59% suffered from vasculitis, 35% of patients had dry gangrene, and 71% had ulcers. Periarterial radial and ulnar sympathectomy was performed for all cases, with digital sympathectomy for 12 fingers. We had 50% complete ulcer healing within 1 month ( p = 0.031), and 100% were completely healed at 6 months ( p < 0.001). Pain scores showed significant reductions at 1 ( p = 0.001) and 6 months ( p < 0.001) of follow-up. Conclusion Distal periarterial sympathectomy demonstrates high success rates in terms of pain relief and ulcer healing in severe digital ischemia.

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Acrocyanosis – A Symptom with Many Facettes

Cited by 16 publications

References 36 publications

Chilblains

Chilblains

Accuracy of the defining characteristics of the nursing diagnosis hypothermia in patients on hemodialysis

Outcomes of periarterial sympathectomy in patients with digital ischemia

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