What is Circumoral Cyanosis?
Cyanosis is a condition where there is bluish discoloration of the skin due to decreased oxygenation or blood circulation. Circumoral cyanosis is a condition where there is bluish discoloration or a bluish tint on the skin surrounding the lips. This bluish shade is often seen in neonates, as the structure of their skin is very thin when compared to adults. Due to this thin skin texture, the blood vessels present under the skin can be clearly seen, leading to the blue tint. Veins are blue in color and upon close observation; we can see the blue shading lent by them on the skin around the lips. Blood circulation through the arteries commonly lends a pinkish tone to the skin. However, there is decreased blood circulation in the surrounding region of the lips and because of the presence of veins; the bluish tint is more prominent around the lips. If the bluish shade is seen on other areas or extends to the lips, then it is important to seek medical attention, as circumoral cyanosis alone is not a serious condition, but if it is associated with other symptoms, then it requires prompt medical attention.
Cyanosis is subdivided according to its severity into central cyanosis and peripheral cyanosis. Circumoral cyanosis is present in both the conditions. Peripheral cyanosis is related with lung disorders and central cyanosis is related with cardiovascular disorders.
Associated Symptoms of Circumoral Cyanosis
- Loss of appetite or anorexia if occurs with circumoral cyanosis then medical attention should be sought.
- Breathing difficulties, this is a very serious symptom and requires careful monitoring, especially seen in a newborn along with circumoral cyanosis.
- Excessive fatigue and not being able to do anything.
Causes of Circumoral Cyanosis in Neonates
It is important to monitor the oxygen supply or oxygenation in neonates, as it is an important sign of their well being. Some of the causes of circumoral cyanosis in neonates include:
Circumoral Cyanosis in Neonates Caused Due to Cyanotic Heart Disease
- This condition can occur due to pulmonary blood flow obstruction which is seen with pulmonary atresia, critical pulmonary stenosis and Tetralogy of Fallot.
- Can also occur due to incongruency between the arterial and ventricular connections.
- If there is a single ventricle, truncus arteriosus and tricuspid atresia, then also it causes cyanotic heart disease and circumoral cyanosis.
Circumoral Cyanosis in Neonates Caused Due to Primary Pulmonary Disorders
Congenital diaphragmatic hernia occurs due to defective diaphragm in a newborn or due to pneumothorax where the air gets trapped between the chest cavity and lungs.
- Respiratory distress syndrome, congenital pneumonia or meconium aspiration syndrome are the conditions that can be found in neonates and lead to circumoral cyanosis.
- Respiratory distress syndrome is a breathing disorder and meconium aspiration syndrome is a condition where the meconium gets mixed with amniotic fluid.
- Asphyxia where there is oxygen insufficiency, severe polycythemia where there is abnormally increased number of RBCs and methemoglobinemia where there is increased content of methemoglobin in the blood are some of the conditions, which can cause circumoral cyanosis.
- Persistent pulmonary hypertension (PPHN) is a condition where there is malfunction in the normal circulatory alteration, which happens after delivery.
Causes of Circumoral Cyanosis in Adults
- Extremely cold weather and high altitudes can also cause circumoral cyanosis.
- Bronchitis, epiglottitis and shock can also cause circumoral cyanosis.
- Carbon mono-oxide poisoning can also cause circumoral cyanosis where there is low oxygen content in the atmosphere, which causes difficulty in breathing and decreased oxygen supply to the body.
Diagnosis of Circumoral Cyanosis
If the patient has circumoral cyanosis, then prompt medical attention should be sought irrespective of presence of other symptoms. Physical examination is done by the doctor to identify the type of cyanosis. If only circumoral cyanosis is present, then it is not a cause for concern, circumoral cyanosis itself is not a serious health issue. However, if it is associated with other symptoms, then can be serious condition. The medical examiner also checks the Airway, Breathing and Circulation (ABC) of the patient. Pulse oximetry is done to assess central cyanosis.
Treatment for Circumoral Cyanosis
- First aid is started to stabilize the patient’s airway, breathing and circulation.
- Supplementary oxygen is started to assist in ventilation or to restore patient’s ventilation. Oxygen supply helps in maintaining the continuous positive airway pressure.
- If hypothermia is the cause of circumoral cyanosis, then appropriate management should be done.
- Bicarbonate therapy is started to treat metabolic acidosis for maintaining the internal pH level.
- If there is any infection which is causing circumoral cyanosis, then antibiotics are prescribed.
- Other serious causes, such as cyanotic heart disease and pulmonary disorders should be treated accordingly to relieve circumoral cyanosis.