Acrocyanosis

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Acrocyanosis is a persistent blue or cyanotic change in the extremities, most commonly in the hands, although it also occurs in the legs and distal parts of the face. Although described more than 100 years ago and not uncommon in practice, the nature of this phenomenon is still uncertain. The term "acrocyanosis" is often improperly applied in cases where blue discoloration of the hands, feet, or face is recorded. The primary (primary) form of acrocyanosis is a benign cosmetic condition, sometimes caused by relatively benign neurohormonal disorders. Regardless of the cause, benign forms usually do not require medical care. A medical emergency will occur if the extremity experiences a period of prolonged cold exposure, especially in children and patients with poor general health. However, frostbite differs from acrocyanosis because pain (via thermal nociceptors) often accompanies previous conditions, while the latter is very rarely associated with pain. There are also a number of other conditions that affect the hands, feet, and faces with related skin changes that need to be distinguished from acrocyanosis: Raynaud's phenomenon, pernio, acrorygosis, erythromelalgia, blue finger syndrome. Diagnosis may be difficult in some cases, especially when these syndromes coexist.

Acrocyanosis can be a sign of more serious medical problems, such as connective tissue diseases and diseases associated with central cyanosis. Other causative conditions include infection, toxicity, antiphospholipid syndrome, cryoglobulinemia, neoplasm. In this case, the observed skin changes are known as "secondary acrocyanosis". They may have a less symmetrical distribution and may be associated with pain and tissue loss.

Video Acrocyanosis

Signs and symptoms

Acrocyanosis is characterized by peripheral cyanosis: persistent cyanosis in the hands or hands, feet, or face. The extremities are often cold and sweaty and may show some swelling (especially in warmer weather). The palms and soles of the feet show a variety of sweat from quite moist to many, but all peripheral beats must have normal speed, rhythm, and quality. Exposure to cold temperatures worsens cyanosis, while it often increases warming. In addition to discoloration, the patient usually shows no symptoms and therefore there is usually no associated pain. The most common signs, discoloration, usually is what drives the patient to seek medical care.

Maps Acrocyanosis

Pathophysiology

The exact mechanism of acrocyanosis is unknown. The current line of thought says that vasospasm in the cutaneous arteries and arterioles results in cyanotic color changes, while the dilatation of compensation in the postkapillary venule causes sweating. Arterioven subcapital artery trachea also occurs. Persistent vasoconstriction in the precapillary sphincter creates a local hypoxia environment, thus releasing adenosine into the capillaries. Vasospasm forces adenosine to enter the capillary bed, where vasodilation of the postkapillary venule. Such differences in ship's tone create a current exchange system that tries to retain heat. Excessive sweating will then be caused by an overwhelming opponent's exchange system. In addition to adenosine, other hormones can contribute to acrocyanosis such as increasing serotonin levels in the blood. This appears to support case studies that report acrocyanosis as an unusual side effect for pediatric patients who use tricyclic antidepressants, because these drugs can inhibit serotonin reuptake and thereby increase their blood concentration. Acrocyanosis has been reported to be associated with many drugs and other substances.

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Diagnosis

Acrocyanosis is clinically diagnosed, based on medical history and physical examination; laboratory studies or imaging studies are not required. Normal peripheral pulses exclude peripheral arterial occlusion disease, where arterial narrowing limits blood flow to the extremities. The pulse oximeter will show normal oxygen saturation. Unlike Raynaud's closely related phenomenon, cyanosis persists. In addition, there is usually no associated trophic skin change, local pain, or ulceration. Capillaroscopy and other laboratory methods may be helpful but only complement the clinical diagnosis in unclear cases, especially when connective tissue disorders may exist.

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Treatment

There is no standard medical or surgical treatment for acrocyanosis, and treatment, in addition to convincing and avoiding cold, is usually unnecessary. The patient is assured that no serious illness is present. A sympathectomy will relieve cyanosis by interrupting the sympathetic nervous system fibers into the area. However, such extreme procedures are rarely appropriate. Treatment with vasoactive drugs is not recommended but traditionally mentioned as an option. However, there is little, if any, empirical evidence that a vasoactive drug (a -adrenergic retraction agent or calcium channel blocker) is effective.

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Prognosis

Although there is no cure for acrocyanosis, the opposite patient has an excellent prognosis. Unless acrocyanosis is produced from other conditions (eg malignancy, antiphospholipid syndrome, atherosclerosis, acute ischemic extremity, bacterial endocarditis), there is no increased risk of disease or death, and no known complications. Apart from the color change, there are no other symptoms: no pain, and no loss of function. Patients can expect to live a normal life. In the treatment of secondary acrocyanosis the primary condition defines the outcome.

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Epidemiology

Although there is no definitive reporting of the incidence, acrocyanosis shows prevalence in children and young adults compared to patients aged thirty years or older. Epidemiological data suggest that cold climate, outdoor work, and low body mass index are significant risk factors for developing acrocyanosis. As expected, acrocyanosis will be more common in women than in men because of differences in BMI. However, the incidence rate of acrocyanosis often decreases with increasing age, regardless of regional climate. This is completely lost in many women after menopause implies a significant hormonal effect.

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In the newborn

Acrocyanosis is common initially after delivery in premature and newborn babies. Interventions are usually unnecessary, although hospitals choose to provide supplemental oxygen for precautions.

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See also

• Pernio (Chilblains)
• Cyanosis
• Peripheral arterial occlusion disease
• Raynaud's phenomenon

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References

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External links

Source of the article : Wikipedia