12 Conditions That Can Cause Blue Nails and When To Go To A Doctor For It?

The changes in the color and characteristics of nails can be an indicator of the overall health of a person. They provide valuable insight into various sometimes serious systemic illnesses. These nail changes may be subtle or can be quite pronounced. The changes may reflect abnormalities in numerous components of the nail to include the nail matrix, plate, or the vasculature. Among the various abnormalities in the nails that indicate an indwelling illness in a person is the presence of blue nails. It usually indicates that the fingertips are not getting the adequate amount of oxygen through the blood.^{[1, 2, 3]}

If a person notes the presence of blue nails, then it is recommended that he or she consult with a physician to get to the bottom of the cause and start treatment for it if required. Cyanosis is the medical term used for lack of oxygen supply to the fingertips. This makes the nails turn blue. The lips and skin may also become discolored and bluish due to this. This lack of adequate oxygen supply is most commonly caused by poor circulation although abnormalities with production of hemoglobin are also one of the potential causes.^{[1, 2, 3]}

Conditions affecting the respiratory and cardiovascular systems also are one of the many causes for blue nails.^{[1, 2, 3]} The article highlights in detail some of the potential causes and treatment options for blue nails and when to contact a physician for it.

In cases where just a single nail is blue then it is not a cause of worry as it is usually caused by an injury or trauma to the nail which causes blood to accumulate under the nails making it blue. However, if all the nails are blue then it indicates cyanosis meaning proper oxygen is not reaching the fingertips. Cyanosis is a symptom of a condition rather than a separate entity. This may also occur as a result of abnormalities in blood circulation where not enough blood flows through the nails causing the nails to turn blue due to lack of oxygen supply.^[3]

At times, Blue Nails can also occur due to changes in temperature especially if the weather outside is too cold. This causes the blood vessels to constrict to keep the body warm affecting blood circulation temporarily. This in turn results in not enough oxygen reaching the fingertips causing them to turn blue. In these circumstances, the color of the nails normalizes once the temperature warms up or the person goes into a warmer area where adequate heating is available.^[3]

In most cases, however, blue nails are an indicator of an underlying medical condition. Normally, abnormalities in the respiratory and cardiovascular systems are responsible for causing Blue Nails but sometimes problems with the blood vessels may also cause the nails to turn blue.^[3]

Respiratory System: There are a host of lung conditions that can cause the nails to turn blue. These include:

1. COPD: This is a term used for a collection of diseases affecting the lungs including chronic bronchitis and emphysema. All these conditions affect the way the lungs are supposed to function resulting in poor oxygen supply to the fingertips causing Blue Nails. While chronic bronchitis causes inflammation and sclerosis of the bronchial tubes, emphysema directly affects the alveoli or the air sacs causing build-up of mucous. According to experts there are more than 30 million people in the United States with a known diagnosis of COPD.^[3]
2. Asthma: This is yet another respiratory condition that often results in a person having blue nails. Asthma causes the airways of a person to become narrow and inflamed resulting in a variety of symptoms. It also affects the way oxygen is supplied to the various parts of the body especially the extremities causing the nails to become blue.^[3] The narrowing of the airway caused in people with asthma causes mucous to accumulate resulting in problems with breathing and frequent bouts of cough. It is necessary for people with asthma to have an asthma inhaler with them as sometimes an asthma attack may be quite serious and potentially life threatening and this rescue inhaler immediately frees up the airway and allows the person to breathe normally.^[3]
3. Acute Respiratory Distress Syndrome: People with this condition have problems with breathing and have increased respiratory rate and pulse. This results in a significant drop in the blood oxygen levels causing limited supply of oxygen to the fingertips resulting in Blue Nails.^[3]
4. Pneumonia: This is an infection of the lungs that can be caused by bacteria, virus, and fungi. It generally follows a severe flu infection. It affects the functioning of the lungs resulting in lack of oxygen supply in the fingertips making the nails blue. Pneumonia is a treatable condition and normally once it is treated the color of the nails normalize.^[3]
5. Pulmonary Embolism: This is one of the more serious causes of Blue Nails. Pulmonary Embolism is caused when a blood clot blocks one of the arteries in the lungs. In most cases, the clot forms in the legs and travels through the blood and gets lodged in one of the arteries of the lungs. This blocks the blood flow to the lungs causing a decrease in oxygen levels in the body resulting in the nails becoming blue.^[3] Cardiovascular Conditions: Aside from respiratory conditions, there are also certain cardiovascular diseases that can cause Blue Nails.
6. Congenital Heart Disease: This is seen mostly in babies who are born with a heart defect. This causes abnormalities in the functioning of the heart affecting the oxygen supply to various parts of the body including the fingertips resulting in the nails becoming blue. While in many babies congenital heart defects are asymptomatic but in some cases the symptoms may be life threatening.^[3]
7. Eisenmenger Syndrome: This is a rare medical condition that affects both the respiratory and cardiovascular system and is believed to be one of the late complications of congenital heart disease. The condition causes hypertension and abnormal blood flow resulting in lack of adequate oxygen supply to the fingertips causing the nails to become blue.^[3]
8. Congestive Heart Failure: Blue Nails at times is also a sign of congestive heart failure, especially if it is associated with shortness, extremity edema, and severe fatigue.^[3]
9. Blood Vessel Abnormalities: Problems with the blood vessels are also one of the causes for Blue Nails. Some of the condition that cause blood vessel abnormalities include.^[3]
10. Methemoglobinemia: This is a medical condition in which there are increased levels of methemoglobin which is a variant of hemoglobin but it does not contain oxygen. This condition can be congenital or acquired such as exposure to chemicals or overuse of antibiotics and local anesthetic. The lack of sufficient hemoglobin in the blood causes inadequate blood supply to the fingertips causing the nails to become blue.^[3]
11. Polycythemia Vera: This is a form of blood cancer that results in excessive amounts of blood cells being produced in the bone marrow. This is also one of the causes for Blue Nails.^[3]
12. Raynaud Phenomenon: This is also one of the causes for blue nails. This condition causes the blood vessels to go into a spasm resulting in decreased blood flow to the extremities resulting in the nails to become blue.^[3]

To treat the underlying cause for blue nails, the physician will first determine the cause. For this, a detailed history and physical exam will be done to look for areas of abnormalities. The physician will especially look for clubbed fingers. If that is the case, then it is most likely that the Blue Nails are being caused due to respiratory or cardiovascular issues. The physician will also check the blood oxygen levels of the patient. The arterial blood gas is also an important parameter when gauging the cause of blue nails.^[3]

The treatment for Blue Nails depends on the cause of it. The following strategies are used to treat the causes for Blue Nails. If it is caused by a congenital heart defect then correcting it through surgery is the most preferred treatment. Additionally supportive oxygen therapy is also quite a preferred mechanism through which adequate oxygen levels are maintained. For people with methemoglobinemia, methylene blue is given to the patient. In cases where blood vessel spasms are causing abnormalities that result in Blue Nails then medications like antihypertensives are prescribed to help the blood vessel relax.^[3]

It is quite common for a person to have Blue Nails especially if the weather outside is extremely cold. However, their color should normalize once the hand warms up.

There are cases where Blue Nails are an indicator that the fingertips are not getting adequate supply of oxygen. This medically termed as cyanosis. It not only affects the nails but also the lips and the skin which all can turn blue. If this is the case, then it is best to consult with a physician to determine a cause and start treatment for it.^[3]

Once optimal blood flow is restored the color of the nails usually gets back to normal. Timely diagnosis and treatment is the key to prevent any unnecessary complications that may arise due to various causes of blue nails that have been described in detail above. This becomes that much more important if there are accompanying symptoms like chest pain, shortness of breath, excessive sweating, dizziness and extremely fatigue. In such a scenario, emergency services should be called up as it requires emergent medical attention.^[3]

In conclusion, Blue Nails is quite a common phenomenon in areas where winters are extremely cold. However, if Blue Nails occur without any apparent cause then it usually indicates an underlying systemic illness. It indicates that the fingertips are not receiving adequate supply of oxygen. This usually happens due to respiratory or cardiovascular issues, although circulatory problems and issues with the blood vessels are also potential causes.^{[1, 2, 3]}

This makes it important for the person to seek immediate medical attention as some of the causes for Blue Nails may be quite serious. A prompt medical consultation to get to the diagnosis and timely treatment can not only treat Blue Nails but also prevent any undesired complications of which some may be serious due to lack of proper supply of oxygen to various parts of the body.^{[1, 2, 3]}

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