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Why Are My Hands Always Cold?

Hands that are cold all the time may be a sign of poor circulation, a thyroid problem, anemia, or Raynaud’s phenomenon. When your hands are very cold from being outside, you can get frostbite. It’s important to warm them up slowly but as soon as possible—and know the signs of severe frostbite.
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Written by
Petrina Craine, MD.
Assistant Clinical Professor of Emergency Medicine, Columbia University
Last updated October 12, 2021

Cold hands questionnaire

Use our free symptom checker to find out what's causing your cold hands.

Cold hands questionnaire

Use our free symptom checker to find out what's causing your cold hands.

Cold hands symptom checker

What cold hands mean

Cold hands usually mean that your body’s core temperature has dropped. When you’re in a cold place, your body protects vital organs like your heart, brain, and lungs by having more blood flow to them and away from your hands.

Cold hands may also turn red, purple, blue, or white, and start to feel numb.

If your hands get cold often, it may be a sign of poor circulation. But it can also be caused by issues like a thyroid problem, anemia, or Raynaud’s phenomenon.

If your hands are turning white, the first thing you should do is get out of the cold right away. Then you want to try to rewarm your hands by placing them in warm (but not hot) water or covering them with a warm washcloth.

What are cold hands a sign of?

“The old saying 'cold hands, warm heart,' as it relates to how physically warm you are, has nothing to do with your level of kindness to others. Cold hands are a sign that your body is trying to protect core (can’t live without) organs like your heart!”—Dr. Petrina Craine

Causes

1. Frostnip/frostbite

Symptoms

  • Cold hands
  • Changes in skin color (such as developing red, white, blue-white, gray-yellow, black skin)
  • Hard and waxy skin
  • Severe joint or muscle stiffness
  • Tingling and numbness in other areas, such as your nose, cheeks, ears, fingers, and toes
  • Blistering (usually occurs when your skin gets warm again)

Frostnip and frostbite are skin injuries caused by exposure to cold. Frostnip, which is milder than frostbite, occurs when your hands cool down. This causes your blood vessels to constrict, meaning less blood is delivered to the tissues in your hands.

Frostbite is more serious and causes ice crystals to form within your skin. In severe cases, it affects tissue deep within the body and causes tissue death. Both conditions usually occur when you’re doing outdoor activities (camping, snow sports, hunting) in the cold.

Frostnip and minor frostbite will go away when you are back in a warm space. Placing your hands in warm water or covering with a warm washcloth can help. You can also apply aloe vera to your skin to relieve any pain.

Severe frostbite, on the other hand, can be life-threatening and requires going to the ER. Treatment includes pain medication and possibly surgery if the tissue has been permanently damaged.

2. Hypothermia

Symptoms

Hypothermia is a dangerous condition that occurs when your body temperature drops to 95°F or lower. When you have hypothermia, your body works quickly to protect the organs at its core, so other parts of your body (known as the extremities, like your hands) start to feel cold and numb. It typically happens when you’re exposed to cold weather or cold water.

Cold hands caused by minor hypothermia often go away when you warm up. But severe hypothermia is a life-threatening emergency that requires going to the ER. Treatments include warm IV fluids and humidified oxygen treatment.

Why do babies have cold hands?

“Infants and children have less body fat than adults to insulate them from drops in temperature, so they may have cold hands even in warmer temperatures. Someone who is older (undergoing changes in skin that make it thinner and less conserving of heat) or pregnant (undergoing various changes in hormones) may also be more likely to develop cold hands. Keep a special eye out for cold hand symptoms in these loved ones in your family.” —Dr. Craine

3. Iron-deficiency anemia

Symptoms

  • Cold hands
  • Feeling tired or weak
  • Shortness of breath
  • Pale or grey-ish skin
  • Feeling dizzy or lightheaded
  • Inability to exercise at full strength
  • Palpitations
  • Fainting

If your diet is low in iron, you may develop anemia. One of iron’s functions is to produce hemoglobin, the oxygen-carrying protein in red blood cells. But when you have iron-deficiency anemia, you don’t have enough healthy red blood cells. This makes it harder for your body to deliver oxygen throughout your body, especially to your hands and feet. That can make them feel cold.

There are several causes of iron-deficiency anemia, including bleeding (from issues like heavy periods, a bleeding peptic ulcer, etc.), low iron intake, and an inability to absorb iron.

Your doctor may recommend treating the condition with iron supplements. But it’s important to take them only under a doctor’s care, since your doctor will first want to rule out very serious causes of iron-deficiency anemia, such as internal bleeding or cancer.

Go to the ER if you have severe symptoms of anemia. You may need to be given iron via IV or a blood transfusion.

Cold hands questionnaire

Use our free symptom checker to find out what's causing your cold hands.

Cold hands symptom checker

4. Hypothyroidism

Symptoms

  • Cold hands
  • Increased fatigue
  • Weight gain
  • Depressed mood
  • Difficulty concentrating
  • Memory problems
  • Changes to hair and skin (like increased hair loss and drier skin)
  • Constipation

Hypothyroidism, or “underactive thyroid,” means that the thyroid gland in your neck isn’t producing enough of its hormones. Thyroid hormones are involved in many body processes, including metabolism. When thyroid hormones are low, your metabolism slows down. This increases your sensitivity to temperature changes, so your hands may feel colder than they usually do.

Hypothyroidism can be caused by several conditions, such as an autoimmune disease (in which your body mistakenly attacks your thyroid gland), surgery or radiation to the thyroid gland, certain medications, pregnancy, or an iodine deficiency. (Iodine is an important mineral for thyroid hormone production.)

Hypothyroidism is easily treated with synthetic thyroid hormone. If you experience symptoms of hypothyroidism, don’t ignore them. They can worsen and cause very low blood pressure and body temperature or even a life-threatening coma.

5. Peripheral artery disease

Symptoms

  • Cold hands
  • Pain when you use your arms
  • Darker or shinier hands
  • Sores on your arm that don’t seem to heal
  • Deceased pulse
  • Slower growth of arm hair

Sometimes cold hands can be a symptom of blood vessel disease, such as blockages or a build-up of a fatty substance called plaque. This can reduce blood flow to your limbs, causing peripheral artery disease (PAD). While it more commonly occurs in the legs and feet, PAD can affect the hands.

PAD occurs more often in adults 50 years of age and older because the risk of blockages increases with age. It also affects smokers and people with diabetes.

Your doctor can treat PAD with medications that improve your circulation, such as blood thinners and cholesterol medication. But if you experience a sudden change in hand color and temperature and a decreased or absent pulse, go to the ER. These are signs of an acute blockage that needs to be treated immediately, possibly with surgery. Treatment also includes quitting smoking, regular exercise, and a healthy diet low in cholesterol.

6. Raynaud’s phenomenon

Symptoms

  • Cold hands and feet
  • Tingling, numbness, and pain in hands and feet
  • Rapid skin color changes (often alternating between red, blue, and white)

Raynaud’s phenomenon is a condition that commonly makes hands feel cold. It’s caused by temporary narrowing of the blood vessels. It can affect your entire hand or just a few fingers, and can also cause cold feet. Though Raynaud’s disease can occur by itself, it is sometimes caused by autoimmune and connective tissue diseases like systemic lupus erythematosus, rheumatoid arthritis, and scleroderma.

An attack can last from a few minutes to a few hours and may be triggered by a stressor, like cold temperatures. Symptoms range from mild to severe. Frequent or long attacks can cause skin sores (ulcers) or even deformities of the hand.

Raynaud’s may be treated with a combination of medications that help improve circulation (such as calcium channel blockers and vasodilators) and lifestyle recommendations like exercising and wearing heavy gloves and socks.

Surgery or Botox injections into the hands may be recommended if Raynaud’s is severe. If your Raynaud’s is caused by another disease, treatment of that disease is also needed.

7. Anxiety

Symptoms

  • Cold, clammy hands
  • Feeling nervous, restless, or tense
  • Palpitations
  • Increased sweating
  • Feeling scared, panicky, or a sense of dread
  • Muscle trembling or shaking
  • Hyperventilating
  • Decreased concentration
  • Difficulty sleeping
  • Irritability
  • Nausea
  • Headaches

Anxiety can make your hands feel cold and clammy at the same time because it causes sweating and constriction of the blood vessels. And if you’re so anxious that you hyperventilate, carbon dioxide levels in your blood can drop so quickly that it causes cold or tingling hands and feet.

If your cold hands are caused by anxiety, it is often brief and will go away on its own or once the anxiety has improved. If you start hyperventilating, try breathing into a paper bag that covers your mouth and nose. This helps increase the amount of carbon dioxide in your body, which restores sensation to your hands and feet.

See a doctor or mental health provider if your anxiety interferes with your daily life. Treatment may include therapy and medication.

8. Peripheral neuropathy

Symptoms

  • Cold hands
  • Tingling, burning, or sharp pain (“pins and needles” sensation)
  • Muscle weakness
  • Sensitivity to temperature changes
  • Rapid changes in your heart rate and blood pressure
  • Feeling off balance (if affecting feet)
  • Decreased sensation

Peripheral neuropathy is caused by problems with your peripheral nervous system, which is made up of the nerve connections that are outside of your brain and spinal cord. Damage to one nerve (mononeuropathy) or multiple nerves (polyneuropathy) most commonly occurs in the hands and feet and can make them feel cold. Symptoms vary depending on the type of nerve that’s affected.

Peripheral neuropathy can be caused by a variety of conditions. These include injuries, infections, genetic diseases, exposure to toxins or chemicals (like tobacco), autoimmune diseases, medication side effects, vitamin B12 deficiency, or diabetes.

Treatment may include pain medications (like gabapentin) to reduce symptoms, lifestyle changes like physical therapy and exercise, and safety measures to prevent injury and infection of the affected body parts.

9. Thoracic outlet syndrome

Symptoms

  • Cold hands
  • Pain in your shoulder or neck
  • Arm fatigue with increased activity
  • Skin color discoloration
  • Tingling, pain, or numbness in arm and fingers
  • Weakness in hand, arm, or fingers
  • Decreased pulse in arm
  • Swelling in arm or hand

The thoracic outlet is the space on either side of the base of your neck. It’s where nerves, arteries, and veins travel beneath your collarbone. If these become compressed or damaged, you can develop a condition called thoracic outlet syndrome (TOS). TOS symptoms can vary but if your hands are cold, that’s a sign that your blood vessels are affected.

TOS has a variety of causes, including trauma from a fall or car accident, repetitive injury caused by a job or sport that requires frequent use of your shoulder and arm, and sometimes from a birth malformation, like being born with an extra rib. Sometimes a specific cause can’t be identified.

Treatment of TOS includes physical therapy and pain relievers. If TOS is caused by a blood clot, then you’ll need blood thinning medication. Surgery is sometimes necessary if these treatments are not effective or if there are signs of worsening neurological damage.

Other possible causes

A number of conditions may also cause cold hands, including:

  • Tumors or abnormalities from blood vessel malformations between veins and arteries (arteriovenous malformation)
  • Buerger’s disease
  • Infections
  • Pulmonary hypertension

Cold hands questionnaire

Use our free symptom checker to find out what's causing your cold hands.

Cold hands symptom checker

When to call the doctor

You should make an appointment with your primary doctor if you’re concerned about your cold hands, particularly if you’re also experiencing the following symptoms:

  • Ongoing fatigue
  • Weight changes
  • Joint pain or stiffness
  • Changes in your digestion (such as constipation)
  • Problems completing exercise or activities that require you to use your hands
  • Constantly feeling cold
  • Ongoing hand pain
  • Frequent or prolonged cold hands or numbness or tingling in your hands
  • Uncomfortably cold hands that turn different colors (white to purple/blue to red)
  • Sores on your fingers or rashes that don’t seem to heal
  • Swelling in the hand or arm
  • Mood changes
  • Difficulty concentrating
  • Memory problems

You may also be referred to a specialist like a vascular surgeon, rheumatologist, or endocrinologist.

Can anxiety cause cold hands?

“I once had a patient who visited the ER because of the sudden onset of cold hands after a particularly stressful event.  He was even told by some people to not go as 'that seems silly.' He ended up being diagnosed with primary Raynaud’s. It’s an important condition to not miss. Don’t let anyone be dismissive of your symptoms.”—Dr. Craine

Should I go to the ER?

Go to the ER if you have cold hands and any of the following symptoms:

  • Sudden change in hand color and temperature
  • Sudden decreased or absent pulse
  • Shortness of breath
  • Chest pain
  • Confusion or lethargy
  • Skin color and texture changes like developing red, white, blue, or black skin (especially if there’s blistering)
  • Fever, especially if it is a moderate to severe fever, which is usually 102°F or higher or has been persistent (lasting longer than 3 days)
  • Seizure
  • Abnormal heartbeat
  • Severe pain
  • Hallucinations
  • Muscle weakness or paralysis
  • Dizziness, lightheadedness, or fainting

Treatments

At-home care

  • Wear protective clothing like gloves (or better yet, mittens) when spending time outdoors in colder weather. Consider layering silk or cotton gloves beneath wool mittens.
  • If your hands are sensitive to cold, you can use gloves or mittens when taking cold objects out of the freezer or refrigerator.
  • Wearing fingerless gloves indoors can keep your hands warm while leaving your fingers free for work.
  • When you need to warm up your hands, use hand warmers or heat packs. Moist heat packs are an even better way to warm your hands because moist heat penetrates your skin more effectively. You can also dip your hands in warm (not hot) water.
  • Practice good skin hygiene, including avoiding excessive skin dryness that can promote breaks in the skin.
  • Drink warm beverages.
  • Avoid or limit caffeine and alcohol use.
  • Eat a balanced diet and exercise regularly.
  • Avoid stress and practice techniques to reduce it, like meditation.
  • Avoid abrupt changes in temperature.
  • Avoid or quit smoking.
  • Go for regular check-ups with your doctor to monitor sugar and cholesterol levels.

Medication

  • Antibiotics for infections
  • Over-the-counter pain medication, like ibuprofen
  • Prescription pain medication, such as gabapentin
  • Medications that help improve your circulation, like blood thinners
  • Medications to lower cholesterol
  • Medications to lower blood sugar, if diabetes is the cause
  • Supplements for mineral or vitamin deficiencies, such as iron and vitamin B12
  • Thyroid hormone supplementation if hypothyroidism is diagnosed
  • Medications to relax blood vessels, like calcium channel blockers and vasodilators, for Raynaud’s
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Assistant Clinical Professor of Emergency Medicine, Columbia University
Dr. Petrina Craine is an emergency medicine physician who hails from Memphis, TN. After graduating as valedictorian of her high school, she moved to Durham, NC to pursue a degree in Biology and a certificate in Global Health. After college, she returned to her birthplace to attend the University of Tennessee Health Science Center College of Medicine. She successfully completed her medical degree a...
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