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When our skin speaks, it’s our job to listen. This is especially important because our skin—the largest organ in our body—can be a clear window into our underlying health, says Sam Awan, MD, a board-certified dermatologist with U.S. Dermatology Partners McKinney.
“[Your skin] is the easiest organ to examine without the need for imaging or invasive testing, and with a trained eye, you can often pick up subtle signs that indicate underlying health issues,” says Dr. Awan.
For example, your skin may turn yellow if you’re dealing with liver issues (called jaundice) or swell around your joints if you have rheumatoid arthritis.
More specifically, your skin can offer clues to how your heart is doing. In fact, some early warning signs of heart disease can manifest in your skin and change its appearance and texture, regardless of your age.
Here, learn the top skin signs of heart disease, according to a dermatologist and cardiologist, plus how you can upgrade your skin-care routine to stay mindful of heart health.
“Our skin can be a clear window into our underlying health.”—Sam Awan, MD, dermatologist
Discolored skin
Skin comes in many shades and tones (it’s even normal for it to appear pink/reddish sometimes), but if you’re seeing blue, it’s a sign there’s something off. “A blue or purple coloring to your skin could mean oxygen is not circulating properly,” says Stacy Rosen, MD, a cardiologist at Northwell Health and senior vice president for the Katz Institute for Women’s Health.
Blue discoloration of the skin—also known as cyanosis—usually happens when there’s reduced blood flow or oxygen to that part of your body. You might notice discoloration on your fingers or toes, in various shades of purple or blue, per the Mayo Clinic.
It’s important to note that the more common causes of blue toes are not associated with heart disease. “For example, we commonly see toe discoloration in patients with COVID-19 or autoimmune conditions,” Dr. Awan says. But if another cause isn’t clear, it could be a sign of small clots or blockages in your arteries, he adds.
And it’s not just shades of blue and purple to be on the lookout for. Skin hyperpigmentation—or areas of your skin that are slightly darker than others—can be a sign of underlying health issues, too, per Dr. Awan. It’s a medical condition called acanthosis nigricans, which causes slight pigmentation on the back of the neck or armpits.
“Acanthosis nigricans and skin tags can be an early sign of developing insulin resistance,” says Dr. Awan. But how does this relate to your heart? Insulin resistance is often a symptom of type 2 diabetes—a condition that doubles your risk of heart disease and stroke, per the Centers for Disease Control and Prevention.
For this reason, “I recommend patients get regular screenings for diabetes with their primary-care doctors, and focus on nutrition, exercise, and sleep to decrease their risk of worsening insulin resistance,” Dr. Awan says.
Swollen legs
When checking your skin for signs of heart issues, it’s not just the color and texture to look out for, but also the size of skin on certain parts of your body, aka swelling. Swollen legs, also known as edema, can be an early sign of heart disease, says Dr. Rosen.
In particular, edema is a common skin symptom of heart failure. When you’re in heart failure, your legs or ankles will start to swell if your heart doesn’t have enough strength to pump blood back up from your lower extremities. This leads to extra fluid collecting in your legs, ankles, thighs, or abdomen, per Harvard Health Publishing.
Heart failure will often come with other symptoms, including the following, per the Mayo Clinic:
- Shortness of breath with activity or lying down
- Fatigue and weakness
- Rapid or irregular heartbeat
- Wheezing/a cough that doesn’t go away or brings up mucus with blood
- Nausea and lack of appetite
- Poor concentration
- Chest pain (if heart failure is caused by a heart attack)
“Swelling of the lower legs and feet can also be a sign of underlying heart, lung, or kidney issues,” says Dr. Awan. “The most common cause of leg edema is wear and tear on the veins of the lower legs. Over time, the veins struggle to send blood back to the heart against the flow of gravity, which leads to fluid pooling in the legs.”
If you notice sudden swelling in only one of your legs, this could be a sign of a blood clot, or more specifically, a deep vein thrombosis (DVT), says Dr. Awan. In this case, it’s best to seek care as soon as possible. A DVT will sometimes have other symptoms like pain, heat coming from the area, skin redness, or visible swollen veins, per the National Health Service.
Not everyone is at risk for developing a DVT. You’re at a higher risk if you have underlying heart issues or have a family history of DVT and then do things like “take long trips, or sit for extended periods of time without moving,” for instance, says Dr. Awan.
“For this reason, I recommend knee-high compression socks when on a long flight or journey, and periodically getting up to stretch and move around,” adds Dr. Awan.
Clubbed fingers
If you’ve noticed the skin around your fingernails or toenails have widened or swelled significantly, you may have clubbed fingers.
“Clubbed fingers or toes are hard to miss, and can be a sign of heart and lung disease, as they signal a lack of oxygen,” says Dr. Awan. This causes the ends of your fingers to get swollen and your nails to become more curved, he adds.
There are many other diseases related to clubbing that involve the heart, with the most common including the following, per the Cleveland Clinic:
- Aortic aneurysm: A bulge in the wall of your aorta, the main artery that carries blood from the heart to the rest to the body
- Congenital heart disease: A birth defect in the heart
- Endocarditis: A bacterial infection in your bloodstream that inflames the lining of the heart valves
Clubbed fingers or toes can be detected next time you’re getting a manicure or pedicure, when you’re clipping your nails at home, or even as you’re applying lotion to your body after a shower. If you notice them, reach out to your doctor ASAP to figure out and treat the underlying cause.
Lesions on or around your eyelids
If you’ve noticed yellow or orange growths on your eyelids (or waxy bumps on your skin in general) while looking closely in the mirror to do skin care or makeup, they’re not just annoying blemishes. They may actually be a sign of high cholesterol or diabetes, says Dr. Rosen.
Also known as xanthomas, these yellow growths are one of the more frequent signs of high cholesterol, especially in older adults. And while seemingly unrelated to your heart, both high cholesterol and diabetes can increase your risk of heart disease, according to the American Heart Association.
“While some types of cholesterol skin deposits can be seen in perfectly healthy patients, others can be a sign of elevated blood cholesterol or lipids,” says Dr. Awan.
Xanthomas don’t go away on their own, so if you’re looking to have the growths removed, they can be treated by a dermatologist, laser specialist, or oculoplastic surgeon. The best way to prevent them from forming is to actively protect your heart health by reducing high cholesterol, avoiding tobacco products, and treating diabetes and high blood pressure, per the Cleveland Clinic.
Purple lines on your nails
Did you know your nails are actually made up of skin cells? Together with your hair, your skin and nails form your body’s outer layer. And when you’re dealing with underlying health conditions, both your skin and nails can be affected in similar ways.
One nail change associated with heart issues is a splinter hemorrhage—or a vertical purple line that develops under the nail, per the Cleveland Clinic. They look like thin wood splinters (hence the name) and are usually from an injury to the nail, but can sometimes be attributed to a health condition, especially if more than one nail has purple lines, says Dr. Rosen.
“Changes to your nails’ appearance including swelling of your fingertips, and red or blue lines under your nail beds could be a sign of heart disease, heart infection, or lung issues,” says Dr. Rosen.
If your heart is the cause, you’ll often get red or purple lines under your nails alongside other symptoms like high fever, weak or irregular heartbeat, or fatigue, per the American Academy of Dermatology.
Splinter hemorrhages don’t usually require treatment if they’re from an injury, but if you suspect they’re due to an underlying condition, reach out to your primary-care doctor or a dermatologist. They can run tests to figure out the underlying cause and come up with a personalized treatment plan.
How to upgrade your skin-care routine to protect your heart
Catching the signs of heart disease early can help lower your risk of more serious complications from the condition, including your risk of heart attack and stroke. “Examining your fingers and toes as you go through your daily skin-care routine can help detect these signs early,” says Dr. Awan.
Here are some ways you can change up your routine to help look out for your heart:
- Take a close look at your eyelids and skin around your eyes for abnormalities (like waxy growths) while applying a cleanser, moisturizer, or while taking off makeup.
- Check out the color and shape of your nails and fingertips next time you clip or paint your nails, or get a manicure. (Try to do the same with your toes/toenails.)
- While applying lotion or dry brushing your skin, take a closer look at the size of your legs and notice if any swelling or unusual redness is present.
- While lathering up with soap or body wash in the shower, check for any abnormal skin discoloration or hyperpigmentation.
Of course, these skin changes don’t always mean you have a heart-related issue; sometimes they have other causes. Either way, it’s helpful to check in every once and a while, and bring up anything unusual to your doctor.
When to see a doctor
If you notice any of these skin changes all of a sudden, or they’ve been around for a while, it’s worth bringing up to your doctor, says Dr. Rosen. This is especially true if they come with other symptoms like pain, shortness of breath, fatigue, nausea or vomiting, high fever, or weakness.
These skin changes may not always mean you have a heart condition, but either way, it’s important to stay on top of regular physical exams and follow up with a dermatologist or your primary-care doctor to get to the root of the issue.
Just keep in mind: “Many of the signs mentioned have common benign mimickers,” adds Dr. Rosen. “So I always emphasize caution before jumping to conclusions.”
