Q: My daughter is one year old. Her feet and hands sometimes turn purplish blue. It happens when she is sick and I normally notice it after a bath. I have been to several doctors and finally we are being referred to a specialist. I was told that is was due to an immature immune system. Since she is one, shouldn't her immune system be fully developed by now? Am I over reacting or could this be serious?

A:Bluish or purplish tinge to the skin and mucous membranes is called cyanosis. If seen only in fingers and toes, it is referred to as peripheral cyanosis while its occurrence around the lips & face is called central cyanosis. Central cyanosis is most often due to conditions that cause low amount of oxygen in the blood (hypoxaemia) or presence of abnormal haemoglobin (methaemoglobin or sulphaemoglobin). Peripheral cyanosis may be due to constriction of the peripheral blood vessels (low temperature, Raynaud’s phenomenon), low cardiac output e.g. heart failure, arterial obstruction e.g. atheroma or venous obstruction. Increased sensitivity of the peripheral vasculature to cold temperature is often seen in children. Please consult a paediatrician who can examine the child and investigate appropriately.