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Symptoms and Signs of Cold Hands and Feet

Doctor's Notes on Cold Hands and Feet

If your feet and hands feel cold, they are signs and symptoms of underlying problems. The underlying problems usually cause somewhat different signs and symptoms. Frostbite and frostnip, while developing, the extremities may tingle, start losing feeling and/or feel like a block of wood. Hands and feet become white, hard and/or waxy with some showing a whitish-purple or yellowish hue and eventually have no feeling. During the warming process, the hands and feet are often painful, swollen and have blister development; severe cold injury may cause some areas (fingers, toes) to turn a black color resulting in tissue loss and/or extremity loss.

Immersion (cold water) injury signs and symptoms cause extremities first to be red, then turn pale in swollen; some people may have blisters, skin breakdown or even skin liquefaction. Perino is a red or bluish, itching and burning rash that can develop after long exposures to cold and wetness without freezing. Other signs and symptoms may occur with diseases such as white to blue to red colored fingertips (Raynaud’s disease), deep-blue fingertips (Cryoglobulin production) and cold urticaria that produce hives or raised red bumps when the person is exposed to cold temperatures.

Causes of cold feet and hands are caused by damage or loss of nerves and blood vessels due to exposure to cold temperatures. Underlying causes include frostbite, frostnip, Perino, Raynaud’s disease, cryoglobulin production (proteins that, when cold, become solids or gels and block circulation) and allergic reaction to cold temperatures (cold urticaria).

Medical Author:
Medically Reviewed on 3/11/2019

Cold Hands and Feet Symptoms

  • Frostbite and frostnip
    • Frostbitten body parts are white and hard or waxy. They may be white-purple or white-yellow.
    • Frostnipped parts are white but not hard and are generally very small areas.
    • Frozen parts have no feeling.
    • During the freezing process, they may tingle or feel like a block of wood.
    • Once frostbitten areas thaw, they may be painless or tingle.
    • When they are rapidly rewarmed in warm water by the recommended method, they may be painful.
    • Over the next few days, the part is often painful and swollen.
    • Blisters may appear, and severely affected areas turn black.
  • Immersion injury
    • Areas affected by immersion injury are first red and then turn pale and swollen.
    • Numbness or painful tingling may occur.
    • After the first few days, the part becomes very red, tingling, swollen, and may have blisters, skin breakdown, or even liquefy.
  • Pernio
    • Pernio is a rash on the lower legs, feet, toes, hands, or ears that may be red or blue and may form scaly areas or lumps.
    • Rarely, affected parts may bleed, blister, or have skin breakdown.
    • Often pernio causes itching and burning.
  • Raynaud's phenomenon refers to constriction of the blood vessels of the hands or feet in response to cold exposure. Raynaud's phenomenon causes white, then blue, then red-colored fingertips and toes and is often painful.
  • Cryoglobulins cause a wide array of symptoms, depending on whether or not internal organs are involved, including deep-blue fingertips.
  • Cold urticaria refers to raised red bumps or hives produced in response to cold exposure.

Cold Hands and Feet Causes

Humans are tropical animals. We are adapted to a warm climate. When exposed to cold, the body tries to stay warm. If the body is cooling off, circulation decreases in the arms, legs, ears, and nose so that the rest of the core body can stay warm. When temperatures are below freezing, ice may form in these areas with less circulation.

  • Nonfreezing cold injuries are also caused by cooling of the skin. In immersion injuries, the nerves and blood vessels are damaged after exposure to cold, wet conditions at or above freezing temperatures.
  • Pernio is caused by exposure to cold for a long period of time without freezing or by very wet conditions.
  • Raynaud's phenomenon is an abnormal narrowing of the blood vessels that constrict with cooling of the fingers or toes.
  • Cryoglobulins are proteins, which are normally dissolved in the blood, that become solids or gels when cold. Cryoglobulinemia is the condition associated with cryoglobulins in the blood, whereby cold exposure leads to bluish discoloration of the fingers or toes.
  • The formation of hives in response to cold exposure of the skin is called cold urticaria.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.