[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [General exam and vital signs](https://durgical.com/en/clinical-exam/#a-general) › Pallor, cyanosis and jaundice [Clinical exam](https://durgical.com/en/clinical-exam/) · [General exam and vital signs](https://durgical.com/en/clinical-exam/#a-general) # Pallor, cyanosis and jaundice - Sign Three colour changes of skin and mucosae that point to anemia, lack of oxygen or excess bilirubin. Updated 2026-11-01 **See it in 3D:** [Skin](https://durgical.com/en/anatomy/skin/) · [Sclera](https://durgical.com/en/anatomy/sclera/) · [Tongue](https://durgical.com/en/anatomy/tongue/) ## Key points - Pallor: look at the palpebral conjunctiva, nail bed and palmar creases; suggests anemia or vasoconstriction (shock, cold). - Central cyanosis: bluish tongue, lips and oral mucosa; hypoxemia from lung disease or shunting heart disease. - Peripheral cyanosis: only in cold fingers and limbs, with pink mucosae; slow flow (cold, low output, Raynaud). - Jaundice: yellow skin and sclerae from high bilirubin; it shows first in the sclerae and under the tongue. - Carotenemia turns palms and soles yellow but spares the sclerae. - In severe anemia cyanosis may be absent despite hypoxemia, because there is little hemoglobin. ## What it is Pallor, cyanosis and jaundice are colour changes best seen in the mucosae, conjunctivae, sclerae, nail beds and palms, especially in darker skin. Pallor suggests anemia or vasoconstriction; cyanosis, more deoxygenated hemoglobin; jaundice, raised bilirubin. They are looked for in daylight, as artificial light can hide them. ## The anatomy it tests - The conjunctiva and nail bed have visible vessels under a thin epithelium, so they show pallor and cyanosis well. - The sclera is rich in elastin, which binds bilirubin; that is why jaundice shows there first. - Cyanosis appears when deoxygenated hemoglobin in the capillaries exceeds about five grams per decilitre. ## How to elicit it - Examine in daylight or white light, never yellowish light. - Gently pull down the lower eyelid and look at the colour of the palpebral conjunctiva. - Ask the patient to look down, lift the upper lid and look at the sclera for a yellow tint. - Ask them to open the mouth and lift the tongue; look at the tongue, lips and the floor of the mouth. - Look at the nail beds, palms and palmar creases; compare with the examiner's hand. - If the fingers are cyanotic, warm the hand and see whether it clears (peripheral) or persists. - Record the colour, where it is seen and how it relates to oxygen saturation. ## What a positive result means - Pallor: iron deficiency anemia (common in children and women in Colombia), bleeding, shock and vasoconstriction from cold or fear. - Central cyanosis: severe pneumonia, COPD, pulmonary embolism, congenital heart disease with right-to-left shunt and methemoglobinemia. - Peripheral cyanosis: cold, heart failure with low output, arterial obstruction and Raynaud phenomenon. - Prehepatic (hemolysis), hepatic (viral hepatitis, cirrhosis) and posthepatic (biliary obstruction) jaundice; in newborns it is often physiological but always assessed. - No cyanosis does not rule out hypoxemia, especially with anemia or dark skin; measure saturation. ## Usefulness and limits - Clinical detection of anemia and mild jaundice is insensitive; they are confirmed with serum hemoglobin and bilirubin. - Jaundice usually becomes visible when bilirubin exceeds about two to three milligrams per decilitre. ## Test yourself Think of the answer, then tap the question to see it. ## How is central cyanosis told apart from peripheral cyanosis? Central cyanosis affects the tongue and oral mucosa; peripheral affects only the fingers and cold areas, with pink mucosae, and improves when the limb is warmed. ## Where does jaundice show first? In the sclerae and under the tongue, because these tissues bind bilirubin before the skin is stained. ## How is carotenemia distinguished from jaundice? Carotenemia turns the palms and soles yellow but spares the sclerae; jaundice stains them. ## Why might a patient with severe anemia not look cyanotic despite hypoxemia? Because cyanosis depends on the absolute amount of deoxygenated hemoglobin, and in anemia total hemoglobin is low. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/pallor-cyanosis-and-jaundice/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Skin](https://durgical.com/en/anatomy/skin/) - [Sclera](https://durgical.com/en/anatomy/sclera/) - [Tongue](https://durgical.com/en/anatomy/tongue/) ## Related - [Anemia syndrome](https://durgical.com/en/clinical-exam/anemia-syndrome/) - [Jaundice: prehepatic, hepatic and posthepatic](https://durgical.com/en/clinical-exam/jaundice-prehepatic-hepatic-and-posthepatic/) - [Pulse oximetry](https://durgical.com/en/clinical-exam/pulse-oximetry/) - [General inspection: appearance, posture, gait and consciousness](https://durgical.com/en/clinical-exam/general-inspection-appearance-posture-gait-and-consciousness/) ## Related conditions - [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/) - [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/) - [Neonatal jaundice](https://durgical.com/en/conditions/neonatal-jaundice/) - [Raynaud phenomenon](https://durgical.com/en/conditions/raynaud-phenomenon/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Blue discoloration of the skin: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003215.htm) (U.S. National Library of Medicine (MedlinePlus), 2025); [Jaundice | Icterus | MedlinePlus](https://medlineplus.gov/jaundice.html) (U.S. National Library of Medicine (MedlinePlus), 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/pallor-cyanosis-and-jaundice/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/pallor-cyanosis-and-jaundice/