Possible Causes of Blue or Purple Lips

Bluish or purple lips can occur when blood vessels temporarily shrink after exposure to cold air or water. But they can also be a sign of a medical problem that is causing a reduced amount of oxygen in your blood. This can happen with conditions like asthma or Addison's disease, but also medical emergencies like carbon monoxide poisoning.

Cyanosis is the term for when your skin and mucous membranes (like the lining of your mouth) take on a bluish color. In addition to blue lips, you may notice a bluish or purple tinge other places, like your nails and earlobes.

This article will go over some of the medical causes for why lips turn purple or blue. It explains related symptoms, how the cause is diagnosed, and when you should seek emergency medical care.

Cyanosis Signs and Symptoms

The main sign of cyanosis is a dusky blue or bluish coloring on your lips that looks unnatural. The word cyanosis comes from the word “cyan,” which is a greenish-blue color.

Cyanotic changes like blue lips can come on suddenly or gradually. Usually, the blue discoloration will go away once the cause is found and treated.

Blue lips often occur with purplish or blue color changes in other parts of the body. It’s most likely to be seen on parts of the body that have a thin layer of skin with a lot of blood vessels underneath. For example, you might notice a bluish coloration on your:

• Tongue
• Gums
• Nails
• Earlobes

Cyanosis might be harder to notice on darker skin tones, where it often appears gray. It's important to check for it carefully and in various places on the body, like the soles of the feet or inside eyelids.

What Causes Blue Lips?

The red blood cells in your body use hemoglobin to carry oxygen to all the tissues. When they dump off oxygen, it changes the configuration of the hemoglobin and makes it a darker color. The blood traveling through the area is as high in oxygen as it normally should be, and this causes blue lips.

Even though this sign is concerning, blue lips do not necessarily mean a part of your body is suffering damage because it's not getting enough oxygen.

For example, an infant born with certain kinds of heart disease might have blue lips and lower-than-normal levels of oxygen in their blood. However, they still can be getting enough oxygen to their body's tissues and no damage is taking place.

In some cases, the body makes up for getting less oxygen—at least temporarily. For example, the body might start making more red blood cells.

Types of Cyanosis

There are two types of cyanosis that typically cause blue lips: central and peripheral. However, blue lips are more likely to occur with the central type than the peripheral type.

• A bluish discoloration of a lot of your skin as well as your lips is called central cyanosis. It is usually a sign of a medical condition that is preventing your body from getting enough oxygen that needs to be treated right away.
• Peripheral cyanosis usually just affects your hands and feet. It happens when the blood vessels in these areas get smaller in response to an environmental change like the intense cold.

Rarely, blue lips and other cyanotic characteristics can be caused by exposure to a toxin (such as silver salts) or to certain medications, like amiodarone.

This is called pseudocyanosis and it does not mean there is a problem with the amount of oxygen in the body.

Medical Causes of Blue Lips

In general, blue lips and other cyanotic changes happen because of a medical problem.

Heart Conditions

Heart disease is a major potential cause that must be checked for. In a newborn, blue lips can be a sign of a heart problem they were born with (congenital) that may need a surgical repair.

In an adult, blue lips can be a sign of heart failure, a heart valve problem, or another type of heart condition.

Lung Conditions

Serious lung problems are another potential cause of blue lips. Many types of lung conditions can cause blue lips and other cyanotic symptoms, including asthma, pulmonary embolism, chronic obstructive pulmonary disease (COPD), or pneumonia.

Nervous System Conditions

Another cause of blue lips is a serious problem with the central nervous system. If the brain is causing a person to breathe less than normal (hypoventilation), it can cause blue lips.

For example, people may breathe less during a drug overdose, a tonic-clonic seizure, or if there is a major bleed in the brain.

Endocrine System Conditions

The hormone cortisol, produced in the adrenal glands, is important to maintaining blood sugar levels, regulating blood pressure, and other key functions in your body. Your skin pigmentation can appear dusky and dark with Addison's disease, among other symptoms related to low cortisol levels.

Low cortisol levels, and disruptions in other glands that work to regulate cortisol (hypothalamus, pituitary) also occur with fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) but their relationship remains unclear and more research is needed.

Acrocyanosis in Children

In infants, a usually harmless condition called acrocyanosis can cause a bluish tinge to the arms and legs. Acrocyanosis can sometimes affect the area around the mouth. This also occurs in small children when swimming in cold water, for example.

The discoloration is temporary and should go away when the child is warmed. However, other causes, such as Tetralogy of Fallot (a congenital heart disease) or an airway blockage, can cause cyanosis that requires medical treatment, including surgery.

Other Medical Problems

Some other potential causes of blue lips include:

• Obstructive sleep apnea
• Being at very high altitudes (acute mountain sickness)
• Shock
• Carbon monoxide poisoning
• Exposure to silver (argyria)
• Genetic blood disorders (e.g., hemoglobinopathy)
  

Diagnosing the Cause of Blue Lips

If you have blue lips, you need to see a provider to figure out what's causing it. Even if it's not a life-threatening emergency, you still need to find the cause and treat it as soon as possible.

A provider will ask you about your medical history and current medical problems and symptoms. They will do an exam to look at how your heart, lungs, and other important body systems are working.

They will also look at your body to see if there are other areas of cyanosis, like your tongue, the inside of your mouth, and your hands and feet. They will examine you for changes in the shape of your fingertips (called clubbing), which can mean a long-term problem where there is not enough oxygen being transported in your blood.

Many tests can help your provider determine if your blue lips are an emergency. These tests also can give clues about the possible underlying cause of blue lips:

• Complete blood count
• Arterial blood gas
• Co-oximetry
• Chest X-ray
• Chest computerized tomography (CT) scan
• Electrocardiogram (EKG)
• Echocardiogram

The timing of blue lips is also important. For example, blue lips present at birth are often from a congenital heart defect. In an adult with a chronic health condition like COPD, blue lips might be a sign that their health condition has gotten worse.

Treating Conditions That Cause Blue Lips

The treatment for blue lips depends on the cause. Your provider will first make sure that your airway is clear and that you can breathe and get enough oxygen. You may need to breathe in extra oxygen or need support with a ventilator to help you breathe.

For a problem like congenital heart disease, surgery might be needed. Other causes will need other specific treatments—for example, antibiotics for pneumonia or a diuretic medication for people with heart failure.

Summary

Blue lips (cyanosis) can be caused by medical conditions, some of which are serious. Depending on a person’s skin color, it can be hard to spot blue lips which can be a sign that a person’s body is not getting enough oxygen.

If you or someone else gets blue lips and is having trouble breathing or passes out, call 911 or go to the nearest ER.