Cold hands: What’s normal and what’s not?

Having cold hands is a common experience. Spending time outdoors in cold weather or an air-conditioned space indoors can cause your hands to feel cold temporarily. Removing items from a refrigerator or freezer, or immersing your hands in cold water can also make them feel cold.

If your hands feel cold even during warm or mild weather, or they take a long time to warm up after being exposed to the cold, you may have a disease or condition that restricts blood flow to the hands. Blood flows from the heart to the hands through the ulnar artery and the radial artery. Exposure to cold temperatures causes the muscles around these arteries to tighten or constrict. This is a normal response, so that the body can conserve heat and protect the vital organs, such as the heart and lungs, from damage.

However, sometimes blood vessels will constrict suddenly, even when there is no apparent cause. This constriction or vasospasm causes the hands to feel cold. The skin of the fingers and hands also might change color from pink to blue or white. When blood flow resumes, your hands might appear red and feel hot.

Frequent or extended vasospasms can result in skin sores (ulcers) or tissue damage.

What diseases and conditions can cause the development of cold hands?

Aside from exposure to cold temperatures or handling cold objects, some diseases or conditions can cause your hands to feel cold. Symptoms may range from mild or moderate to severe. If your symptoms are mild or occur occasionally, you might ignore them. If symptoms become more frequent or severe, your condition may require treatment.

Raynaud’s -This is a fairly common disorder that affects the arteries that supply blood from the heart to other parts of the body. It results in temporary constriction or narrowing of the blood vessels, called a vasospasm. Usually, the fingers and hands are affected. In about 40 percent of cases, the toes are also affected. Raynaud’s may only affect one or two fingers or toes. It may affect different parts of the body at different times. During an attack or episode, blood flow to the hands and/or the feet is restricted. Attacks can last from a few minutes to an hour. An attack can be triggered by stress or a sudden or brief exposure to cold temperatures.

There are two forms of Raynaud’s syndrome: primary and secondary.

Primary Raynaud’s disorder has no known cause. It occurs more frequently than the secondary type and is usually less serious.

Secondary Raynaud’s disorder is associated with a more serious underlying condition, disease, or factor. Some of these underlying causes include connective tissue diseases or immune system disorders.

Some of the more common causes of secondary Raynaud’s include:

• Rheumatoid arthritis (a disease causing inflammation in joints and resulting in painful deformities)
• Lupus (a disease in which the immune system attacks healthy tissue)
• Scleroderma (hardening of the skin and other body tissues)
• Atherosclerosis (deposits of plaques of fatty material on the inner walls of arteries)
• Pulmonary hypertension (a type of high blood pressure that affects the arteries in your lungs and the right side of the heart)
• Certain blood disorders, such as cryoglobulinemia (that cause damage and inflammation of the blood vessels throughout the body); and polymyositis (an inflammatory disease that causes muscle weakness)
• Sjögren’s syndrome (a disorder that causes dryness of the eyes and mouth)
• Buerger’s syndrome (blockage of arteries to the feet and hands, leading to pain and tissue damage)

Other causes of secondary Raynaud’s may include:

• Repetitive motions - Repetitious movements associated with typing or playing a musical instrument for long periods may be a factor. Use of electrical tools that vibrate, like a drill or jackhammer, might trigger attacks.
• Injuries to the hands - Injuries to the hands caused by an accident, surgery, or frostbite.
• Use of some workplace chemicals such as vinyl chloride.
• Use of medications - Some medications linked to secondary Raynauds’s are chemotherapy agents, birth control pills, nonprescription cold and allergy medicines, and beta blockers to treat hypertension. Other medications include narcotics, migraine headache drugs containing ergotamine, and diet pills.

Cold hands may also be a symptom of:

• Hypothyroidism - An underactive thyroid gland may make it more difficult for a person to tolerate the cold. It is also associated with other diseases, such as rheumatoid arthritis, Sjogren’s syndrome, and lupus.
• Peripheral artery disease (PAD) - When plaque (a fatty substance) builds up on the walls of the arteries, they may become blocked and cause cold hands and feet. PAD occurs more often in adults who are age 50 or older. Those who have diabetes or smoke are at a greater risk.

How will my doctor diagnosis what is causing my cold hands condition?

Your doctor will ask you about your medical history, including any injuries, accidents, or surgeries involving the hands or fingers. The doctor will ask about your symptoms and conduct a physical examination. He or she will examine your fingers, toes, and nails for abnormalities. Some of the tests involved in diagnosing primary and secondary Raynaud’s include:

• Cold stimulation test - A small device is taped to the fingers to measure their response to changes in temperature. The hands are exposed to cold, often by immersing them in ice water. The device detects how long it takes for the fingers to return to their normal temperature.
• Nailfold capillaroscopy - A drop of oil is placed on the base of the fingernail before it is examined under a microscope. If the arteries appear abnormal, it could indicate a disease such as scleroderma.
• Blood testing - Blood tests may be performed to look for other conditions and causes of secondary Raynaud’s or rule out other conditions.

How are cold hands treated?

The treatment will depend on the underlying disease or condition. There is no way to prevent or cure primary Raynaud’s. However, the number or severity of the attacks can be reduced by adopting certain lifestyle changes or taking various medications.

In the case of secondary Raynaud’s, the underlying cause needs to be determined so it can be treated.

Lifestyle changes that may help to reduce the number of episodes or their severity include:

• Limit or avoid use of tobacco products. The use of cigarettes or other products that contain nicotine should be avoided. Limit exposure to secondhand smoke.
• Wear mittens (rather than gloves), hats, and other protective clothing when spending time outdoors. Gloves or mittens may be worn when handling cold objects, such as items stored in the refrigerator or freezer. Use hand warmers, such as battery-operated devices or heat packs. Foot warmers may be helpful.
• Avoid abrupt changes in temperature. Sudden changes in temperature may trigger an attack, such as entering an air-conditioned room. Set air-conditioners to a higher temperature, wear warm clothing, or move to a warmer area.
• Avoid stress. Practice stress reduction techniques.
• Exercise regularly.
• Avoid beverages that contain alcohol.
• Protect hands and feet from injuries, including cuts and bruises.
• Avoid caffeinated beverages.

Medications - Certain drugs may be helpful in increasing blood flow to the hands and fingers. They include some drugs used to treat hypertension, such as

• Calcium channel blockers
• Alpha blockers
• Angiotensin converting enzyme (ACE) inhibitors

Antibiotics may be given to treat skin sores caused by infections in the fingers or hands.

Surgery - Surgery may be necessary to block the nerves in the hands if other treatments are not effective. Injections to block the nerves may be an alternative to surgery.

If tissue damage occurs, the diseased tissue may have to be removed surgically. In the most serious cases, gangrene (death of body tissue) may develop. This may require amputation (surgical removal) of part of the hand.

What’s the prognosis?

Most people with primary Raynaud’s are able to manage their symptoms by adopting lifestyle changes and through ongoing medical treatment. Patients with secondary Raynaud’s may require specialized treatment to manage their underlying condition. It is important to schedule regular exams with your physician to prevent damage to the hands or fingers. Report any changes or worsening of symptoms immediately to your healthcare provider. Seek prompt treatment if you notice sores on your hands or fingers, or on other areas of the body.

Besides having cold hands, what other symptoms indicate I should see a doctor?

Symptoms that indicate a doctor visit may be needed include:

• Pain in the hands and fingers that occurs many times a day, for several days.
• Changes in skin color. The fingers may appear white, blue or purplish.
• Thickening or tightening of the skin.
• Tingling, throbbing, numbing, or burning sensations when the blood flow resumes. The skin may appear red.
• Changes in nail appearance.
• Cracks or sores on fingertips that are difficult to heel.