Acrocyanosis is a change in the color of the skin on the distal parts of the trunk, which acquire a bluish tinge. At the heart of the pathogenesis of acrocyanosis development is the disturbance of blood flow along the microcirculatory bed at the level of the arterial capillary network in the thickness of the skin.
Cyanotic skin coloration in the distal limbs and face is a reflection of cardihaemodynamics as a whole, so the appearance of this symptom in a person suffering from chronic cardiac pathology is considered an unfavorable prognostic criterion.
Acrocyanosis refers to one of the main criteria for the development of chronic cardiovascular insufficiency, but one should also remember other possible etiologic factors provoking an acute change in the coloration of the skin of varying degrees of intensity.
The maximum manifestations of acrocyanosis are noted in patients after cardiosurgical operations for valvular heart disease with the establishment of a venous-arterial shunt.
Causes of acrocyanosis
Depending on the nature of the occurrence, there are several specific varieties of acrocyanosis: essential (mostly observed in girls during the active pubertal period) and anesthetic (it is facilitated by the direct influence of the cold stimulus on the skin).
If we consider the pathogenetic chain of the development of acrocyanosis, the main link is the increase in the concentration of the reduced hemoglobin fraction in the venous blood that occurs with a significant decrease in the rate of blood flow through the vessels, and also with the increased consumption of oxygen by various tissues and structures.
A typical classical variant of acrocyanosis is the central type, the cause of which is the total hypoxic damage to the peripheral tissues of the human body, resulting from a decrease in the level of oxygen saturation of the blood of the small circulation.
Acrocyanosis is a sign of cardihaemodynamics of the right heart, in contrast to the diffuse form of cyanosis, which is a reflection of the increase in the concentration of reduced hemoglobin in the entire flow of circulating blood.
A separate etiopathogenetic form of acrocyanosis is spasmodic, which is observed among the adolescent age, suffering from asthenic vegetative syndrome, accompanied by spasmodic small-caliber vessels in response to any stimuli (cold, stress, physical activity). In this situation, small subcutaneous and intradermal arterial vessels of the capillary network are more damaged.
Manifestations of acrocyanosis
The intensity of cyanotic coloring of the skin depends on the density of the skin structure and its individual transparency. In addition, the severity of the cyanosis of the skin has a direct effect on the state of the vascular wall. In the initial stage, acrocyanosis of the lips is most often observed, which acquire an unnatural cyanotic shade, which is clearly distinguished against the background of unchanged coloration of the mucous membrane of the mouth and tongue. The next most frequent occurrence of acrocyanosis localization is a change in the coloration of the skin of the distal sections of the lower and upper extremities with the concomitant change in the nail plates. A rare localization of acrocyanotic changes, which are observed in extreme degree of hemodynamic disorders, is the skin of the auricles, chin and nose.
In addition to changing the color of the skin in acrocyanosis, the local skin temperature always decreases, so this category of patients constantly complains about the increased sensitivity of the skin to temperature stimuli. Pathognomonic symptom of chronic heart failure , which in most cases is combined with acrocyanosis, is a local hyperhidrosis of the skin.
The principal difference between acrocyanosis is the local spread of all the above symptoms, which differs from the diffuse form of cyanosis . Pain sensations in the area of altered skin are not characteristic for acrocyanosis, but most patients suffering from this pathology for a long time, notes frequent episodes of convulsive contraction of muscle fibers in the affected area, which in some cases is accompanied by unpleasant sensations.
In some situations, visual manifestations of acrocyanosis accompanying the course of chronic cardiac pathology can simulate Reynaud's syndrome . The main difference of acrocyanosis in this situation is its resistance regardless of external factors. Despite the fact that acrocyanosis manifests itself as a sign of circulatory disorders, this pathology under no circumstances is accompanied by the development of trophic skin disorders in the affected area, which is also its pathognomonic criterion. Accordingly, the damage to the main neurovascular bundle is also not observed and the pulsation in the projection of the altered skin will not be disturbed.
Due to the fact that acrocyanosis is most often observed in cardiac patients suffering from congestive heart failure, along with changes in the color of the skin and their local temperature, there is marked swelling of the affected areas with predominant localization in the distal parts of the lower extremities.
Typically, a typical clinical symptomatology makes it possible to establish reliably the presence of acrocyanosis in a patient, but in a difficult situation with the purpose of revealing the latent form of this pathology, a test should be conducted with exposure to the skin of the cold stimulus. In the presence of signs of a violation of blood microcirculation in humans, when an even slight cold stimulus is applied, pronounced blueing of the skin, with limited localization, is noted. When the cold stimulus is stopped, the color of the skin becomes normal.
In contrast to the adult category of patients, acrocyanosis in newborns is not always an unfavorable prognostic sign and can be observed even in a healthy child, especially those born before the due date. The usual localization of acrocyanotic manifestations is the foot, hand, and nasolabial triangle. A characteristic feature of acrocyanosis in children during the newborn period is its intensification with expressed anxiety, crying and hypothermia. However, during a primary examination of a newborn child with signs of acrocyanotic skin changes, one should remember about severe cardiovascular congenital malformations, diagnosis of which is currently not difficult.
Treatment of acrocyanosis
Due to the fact that acrocyanosis is not an independent nosological form, there is no specific treatment for a particular pathological condition. Complete elimination of signs of acrocyanosis is possible only in the case of an absolute cure of the main cardiac pathology, which was a provocateur of circulatory disorders at the microcirculatory level. Even though acrocyanosis, as a pathological symptom, is rarely prone to rapid progression, this condition needs timely symptomatic and preventive treatment, since serious vascular pathologies can develop on its background.
As a symptomatic treatment aimed at strengthening the vascular walls, a medicinal vitaminized drug based on B-vitamins in parenteral form has a good positive effect. A nicotinic acid has a good vasodilating effect in a daily dose of 0.015 g orally.
Patients suffering from acrocyanosis for a long time are well tolerated by various types of external topical treatment (rubbing and compresses with camphor ointment), as well as physiotherapeutic procedures (ozocerite application, mud therapy, diathermy and massage), after which significant improvement is noted.
After it is possible to compensate for hemodynamics in a patient with chronic cardiovascular insufficiency , it is necessary to recommend the use of preventive medications in the form of systematic walking and tempering procedures to this category of patients. Patients with acrocyanosis should avoid exposure to an aggressive cold stimulus, which adversely affects the state of intradermal microcirculation.
In most situations sympathectomy has a good effect on the removal of signs of acrocyanosis, but this operative manual can not be included in the mandatory list of medical manipulations.
Due to the fact that acrocyanosis is an external manifestation of vascular insufficiency, which is of a permanent nature, the continuous use of medications is unacceptable. In this situation, traditional non-traditional medicine means for both external and internal use (honey infusion, tincture of pumpkin seeds, baths with calendula and St. John's wort) are a good help.