Complexion, Pallor and Cyanosis

• Complexion refers to the color of the skin and mucous membranes.
• The complexion assessment includes pallor, jaundice, and cyanosis.

Pallor

• Pallor is the color of skin minus the typical redness.
• Pallor indicates the level of hemoglobin or blood perfusion.
• Pallor can be detected on the inner surface of the lips, the palm of the hand, especially the palmer creases, the nail bed, and the mucous membranes such as the conjunctiva and buccal membranes.
• Anemia, low COP, and meds such as vasopressin can lead to it
• Edema of the face and skin, increased skin thickness in cases of hypothyroidism, and decreased skin pigmentations as in panhypopituitarism

Cyanosis

• Cyanosis is defined as a bluish discoloration of the skin and mucous membrane.
• It results from an elevated percentage of reduced hemoglobin, which is equal to or greater than 5 grams, in capillary blood.
• Normally the hemoglobin does not increase past 2.5

Types of Cyanosis

• Central cyanosis is often related to cardiac or respiratory causes.
• Central cyanosis is typically found on the lateral edge of the underside of the tongue.
• Peripheral cyanosis is located at the nail bed, the outer surface of the lip, the tip of the nose, and the ear pinna.
• Peripheral cyanosis is caused by stagnation of blood in peripheral circulation.
• Generalized cyanosis is when a baby has a total anomalous pulmonary venous return and an oxygen saturation level of 80%.
• Perioral cyanosis is when a baby has mild cyanosis above the lips, but the mucous membranes remain pink.
• Differential cyanosis is defined as cyanosis in one half of the body and normal color in the other half.

Jaundice

• Jaundice, also known as icterus, results from an abnormally high accumulation of bilirubin in the blood, causing a yellowish discoloration of the skin and deep tissues.
• Jaundice is usually detectable when serum bilirubin concentration rises above 50 µmol/L (3 mg/dL)
• The sclera of the eye, comprised of elastic fibers, is often one of the first areas where jaundice is detected.

Major Causes of Jaundice

• Excessive destruction of red blood cells
• Impaired uptake of bilirubin by the liver cells
• Decreased conjugation of bilirubin
• Obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts.

Clubbing

• Clubbing is a painless enlargement of the distal phalanges.
• First degree clubbing features an absent window sign.
• Second-degree clubbing has a "parrot peak".
• Third degree clubbing has a "drumstick" appearance.

Edema

• Pitting edema can be caused by cardiac, renal, or liver diseases and nutritional hypoalbuminemia.
• Non-pitting edema can occur from lymphatic filariasis.