Missing limb ischemia in dark-skinned patients: The badinjal sign

Limb ischemia is acute, chronic, or acute on chronic, and the prevalence of the latter is rising with the presence of an increasing aging population. When occlusion to the flow of blood is sudden, it results in acute limb ischemia, the early diagnosis of which is vital for the salvage of the limb. In chronic ischemia, the occlusion is progressive, and diagnosis can alter the quality of life for a patient, besides limb salvage. Dark skin tones are more common in Africa, India, Asia, and the Middle East. Diagnosis of limb ischemia is missed in this subset because the classical "pallor" described in Caucasians is not seen. It is seen as shades of duskiness, like the purplish hue on an aubergine - also known as Badinjal, Eggplant, or Brinjal. This article explains why there is a color discrepancy and a need for healthcare professionals to be aware, hence improving limb salvage.