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5 Causes of Cold Skin

Cold, clammy skin is usually from being out in the cold for too long, though some people may be extra sensitive to cold, or you may have a health condition like hypothyroidism, Raynaud’s syndrome, low blood sugar, or a blocked artery. Whatever the cause, getting to a warmer environment is the best treatment—but be on the lookout for signs of frostbite.
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Last updated October 5, 2021

Cold skin questionnaire

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

Cold skin questionnaire

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

Cold skin symptom checker

What is cold skin?

Normal core body temperature is around 98℉, but the “shell” temperature of the skin is usually about 4 degrees lower and it changes more often in response to the environment.

If your skin is often cold and clammy, it may be a sign of sensitivity to cold temperatures or your body’s inability to regulate its temperature. Cold skin can also mean that the body is losing heat faster than it can produce it.

In cold weather, you can get hypothermia (when your core temperature gets too cold) or frostbite if you aren’t dressed warm enough or if you’re outside for a long time.

Medical conditions like hypothyroidism, low blood sugar, or a blocked artery can also lead to cold skin that’s unrelated to the weather. You should see a doctor if you have cold skin that doesn’t get better after you come in from the cold or your skin is often cold even when you’re in a warm environment.

Why do I feel the cold so much?

“Prevention is the best treatment for cold skin related to environmental exposure!  Plan ahead if you might be exposed to cold temperatures or wet conditions. Take extra clothing layers, rain gear, and a full change of clothes. Try to expect the unexpected so you’re not surprised by sudden weather changes.  Know where you’ll go if you need to warm up or wait for a downpour to end.” —Dr. Anne Jacobsen

Causes of cold skin

1. Raynaud’s syndrome

Symptoms

  • Cold hands
  • Blue or pale fingers
  • Numbness or tingling sensation in hands

When you’re exposed to the cold, your blood vessels constrict, or become narrower, to conserve heat and keep your core warm. This decreases blood flow to the skin and the extremities (hands and feet).

In people with Raynaud’s syndrome, the blood vessels overreact, severely limiting blood flow. This can occur from a very brief cold exposure, like when you open the door of the freezer. It mostly affects fingers, but it can also happen in the toes, ears, or nose. It can be uncomfortable but not serious, and your skin should return to normal once you warm your hands.

Treating Raynaud’s syndrome

You can prevent symptoms by avoiding cold temperatures or wearing gloves and a hat. If you do develop symptoms, go inside and warm your hands, and your skin should return to a normal temperature and color. Some people take medication to dilate, or relax, blood vessels. Emergency treatment is necessary when you try to warm up but your symptoms do not get better.

Why am I always cold?

“Patients with hypothyroidism may describe feeling cold all the time, cold skin, or dry skin. They report dry and brittle hair with hair loss. Patients gain weight without an obvious change in their diet or exercise patterns. They may feel tired all the time, even with adequate sleep. They may have bowel changes like constipation, and women can have irregular periods or infertility.” —Dr. Jacobsen

2. Hypothyroidism

Symptoms

  • Cold, dry skin
  • Weight gain
  • Cold intolerance
  • Hair loss
  • Constipation
  • Menstrual changes in women

Hypothyroidism means you have an underactive thyroid gland, which is most often caused by an autoimmune disease.

Symptoms can be vague and hard to distinguish from other conditions, though a blood test can diagnose it. It is more common in women and older adults. People who have hypothyroidism may feel cold all the time, or feel cold even when they are in a place that is a moderate temperature.

Treating hypothyroidism

Hypothyroidism is treated with a thyroid hormone medication. Blood tests are done regularly to check that the right dose of medication is being used.

Cold skin questionnaire

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

Cold skin symptom checker

3. Hypoglycemia (low blood sugar)

Symptoms 

  • Cold skin
  • Sweating
  • Feeling shaky
  • Confusion
  • Dizziness
  • Loss of consciousness, if severe

Hypoglycemia occurs when your blood sugar (glucose) level is lower than normal. This can happen in people with diabetes, and is often a side effect of medications like insulin.

Hypoglycemia is also caused by some medications for other conditions (like beta-blockers for high blood pressure and some antibiotics), lung or kidney problems, serious infections, or heavy alcohol use. You can have mild symptoms from skipping meals or doing strenuous, prolonged exercise without refueling.

Low blood sugar can set off your “fight or flight” response. Blood vessels in the skin constrict to improve blood flow to the vital organs, and you start to sweat, causing cold skin.

Treating hypoglycemia

Low blood sugar is diagnosed with a blood test that takes a couple of minutes (it can be done at home or by a doctor). If you think you have low blood sugar and aren’t able to check your glucose level, you can try to treat yourself.

Having high-sugar foods like juice or a candy bar can help. In some cases, blood sugar can rise temporarily and then drop down again, so closely monitor your levels. Injections or IV medications might be needed for people who have severe or ongoing symptoms.

4. Peripheral arterial disease

Symptoms 

  • Cold feet
  • Calf pain that comes on when exercising and goes away with rest
  • Hair loss on lower legs
  • Shiny skin on lower legs
  • Foot pain
  • Foot numbness or tingling
  • Slow wound healing on legs or feet

Peripheral arterial disease (PAD) is when fat builds up inside the arteries of the legs, causing them to narrow. This makes it harder for blood to reach the lower legs. It is most common in people over the age of 65, and smokers. People with diabetes and those who have had a heart attack or stroke are also at higher risk.

As the narrowing becomes more severe, the decreased blood flow causes pain. Eventually, some people develop a complete blockage of blood flow through an artery, which causes sudden, severe pain, and pale, cold skin. This is an emergency that can cause permanent tissue damage and, in extreme cases, amputation may be required if blood flow isn’t quickly restored.

Treating peripheral arterial disease

It’s important to manage the conditions that lead to PAD including diabetes, high blood pressure, high cholesterol, and smoking. Medication can be given to thin the blood or widen the blood vessels.

People with severe symptoms or a complete blockage may need an injection of medication to dissolve the blood clot, angioplasty (a procedure to open the blocked vessel), or bypass surgery (using a blood vessel from elsewhere in the body to direct blood to the leg).

What does it mean when only one foot is cold?

“Let your doctor know if you are having cold skin that just affects one foot or leg. This could indicate a problem with blood flow through your arteries. It’s an emergency if the symptoms develop suddenly and cause severe calf or leg pain.” —Dr. Jacobsen

5. Frostbite

Symptoms

  • Cold, prickly skin
  • Numbness
  • Red, white, or blue skin
  • Skin that is waxy looking
  • Difficulty moving fingers or toes

Frostbite is when exposure to extreme cold causes skin and underlying tissue to freeze. This can happen even if you’re wearing gloves or other clothing if it’s really cold outside, or if you become wet. It often develops in the fingers and toes, but can also affect the nose, ears, cheeks, and chin.

You may feel cold at first, and then numb. If frostbite continues, tissues may turn black and die.

Treating frostbite

If you develop symptoms of frostbite that don’t go away after you try to warm up inside, you may need medical attention. You should also see a doctor for blistering skin, fever, or if you have shivering or bodywide coldness that doesn’t get better.

Treatment will depend on how severe it is. The skin is rewarmed, usually with a warm water or whirlpool treatment. This can be very painful, so pain medication can be given. Wound care may be needed for blisters or damaged skin.

Surgery is sometimes needed to remove dead tissue, but this is typically done a few weeks after the frostbite occurs.

6. Hypothermia

Symptoms

  • Cold skin
  • Shivering or feeling like you can’t get warm
  • Slow heart rate
  • Purple or blue extremities
  • May become confused

Hypothermia is when your core body temperature drops below 95℉. With prolonged exposure to very cold temperatures, the body can lose the ability to maintain a safe core temperature.

When you start to feel cold, the brain (specifically the hypothalamus) sends signals to the body to conserve heat and maintain good blood flow to your organs. This causes shivering and blood vessels near the skin to constrict. If it continues for too long, the cold and decreased blood flow can cause you to become confused or even lose consciousness.

It usually happens in winter, but it can happen in temperate climates. According to the CDC, hypothermia occurs most often in older adults with inadequate food or heating, infants sleeping in very cold rooms or outdoor-like conditions, and individuals exposed to the elements (due to homelessness, hiking, or other outdoor activities).

Alcohol or illicit drugs can make people unaware of the weather and their surroundings, which can increase risk of hypothermia even at fairly mild temperatures.

Treating hypothermia

Hypothermia is a medical emergency that requires immediate treatment. A person with hypothermia should be moved indoors where it is warm and not cold or windy. While waiting for medical assistance, wet clothing should be taken off and layers of warm, dry clothing or blankets should be put on. People who are awake and not confused can drink warm liquids.

At the hospital, warm fluids may be given through an IV. Other treatments include a forced air blanket or water circulation pad, heat lamps, and hot packs. People with severe hypothermia will need to be hospitalized to monitor for complications.

Other possible causes

Cold skin may be from an imbalance or problem with how your body controls temperature (thermoregulation). This can include imbalances in the hypothalamus, the area of your brain that processes temperature. It can also be due to metabolic causes, including lack of body fat. Other conditions that may have cold skin as a symptom:

  • Anorexia or low body weight
  • Amyotrophic lateral sclerosis (ALS)
  • Spinal cord injury
  • Anemia
  • People with traumatic injuries or shock
  • Sepsis (severe infection)

Cold skin questionnaire

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

Cold skin symptom checker

When to call the doctor

  • Hands become cold, discolored, or numb when you are exposed to the cold
  • Cold intolerance or cold skin, especially if you also have other symptoms like fatigue, weight gain, hair loss, or constipation
  • Episodes of low blood sugar that you can’t control at home
  • Calf pain when walking that goes away with rest

Should I go to the ER for cold skin?

You should call 911 if you have any of these symptoms:

  • Exposure to cold temperatures and can’t get warm
  • Severe pain, cold skin, color change, and numbness in your hand or foot (if it isn’t related to cold exposure)
  • Racing or slow heart rate while resting (over 100 beats per minute or under 60 beats per minute)
  • Changes in your alertness or trouble staying awake or keeping track of a conversation
  • Dizziness
  • Low blood sugar that doesn’t improve after eating something sugary

At-home care

If you get cold hands from being exposed to the cold:

  • Go inside
  • Take off wet clothing
  • Put on warm clothes or blankets to get warm
  • Drink warm liquids

If you have diabetes or you have a history of hypoglycemia:

  • Eat regular meals
  • Take medications exactly as directed
  • Monitor blood glucose levels as directed by your doctor
  • If your blood sugar is low, eat something sugary and monitor glucose closely

Speciality treatment options

  • Diagnostic testing like X-ray, ultrasound, CT scan, or MRI to determine the cause of cold skin and evaluate the severity
  • Adjustment of medications for diabetes, high blood pressure, and cholesterol if they are contributing factors
  • Medications to treat hypothyroidism or peripheral arterial disease
  • Surgery may be necessary for severe peripheral arterial disease or complete vessel blockage, or for dead tissue in hypothermia.
Share your story
Dr. Jacobsen is a board-certified Emergency Medicine physician and writer for Buoy Health. She received her undergraduate degrees in Chemistry and Biology from Macalester College (2006) and graduated from the University of Kansas School of Medicine (2010). She completed an Emergency Medicine residency program at the University of Missouri-Kansas City (2013). She practices community Emergency Medic...
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