Polycythemia vera commonly presents with which skin finding?

• A. Pale complexion
• B. Ruddy complexion with blue lips
• C. Jaundice
• D. Cyanosis of fingertips

Answer: (B)

In polycythemia vera, there is overproduction of red blood cells, which raises the hematocrit and makes the blood more viscous. This hyperviscosity leads to increased skin perfusion and a flushed, ruddy (plethoric) complexion, especially on the face. The lips can take on a blue tint because the high red cell mass and slower blood flow can give deoxygenated blood a slightly cyanotic appearance in peripheral vessels. So a ruddy facial color with blue lips reflects the increased red cell mass and altered blood flow seen in this condition. Pale skin suggests anemia, jaundice would come from increased RBC breakdown rather than just excess production, and cyanosis of the fingertips points to hypoxemia rather than the characteristic facial plethora of polycythemia vera.