Cold hands and feet: causes, red flags and when to get it checked

The hands and feet are the first areas the body sacrifices to keep the core warm. Vessels in the skin tighten, reducing blood flow and temperature. In some people this response is exaggerated, and in others it reflects reduced heat production, anaemia or true narrowing of the arteries.

• Normal variation, cold environments, low body weight and anxiety, particularly in women.

• Primary Raynaud phenomenon: episodes of white, blue then red fingers or toes triggered by cold or stress, often starting in the teens or twenties.

• Underactive thyroid: cold intolerance, tiredness, weight gain, dry skin and constipation.

• Anaemia and low iron: pallor, tiredness and cold hands, particularly in menstruating women.

• Medicines: beta blockers, some migraine drugs, decongestants, and some chemotherapy drugs.

• Smoking and peripheral arterial disease: cold feet, calf pain on walking, shiny skin and weak pulses.

• Secondary Raynaud with scleroderma, lupus or other connective tissue diseases, often with skin tightening, ulcers or joint pain.

• Diabetes-related nerve and vessel damage, and rarely blood clots or vasculitis.

Sudden cold, white or blue foot with pain, skin ulcers or blackening of fingertips, Raynaud starting after 40, one hand or foot affected, joint pain, rash, thickened skin, calf pain on walking, or tiredness with weight gain and dry skin should prompt review.

• Call 999 or go to A&E: a sudden cold, pale or blue limb with severe pain or numbness.

• Same-day GP: new digital ulcers, blackening of fingertips, or a foot sore that is not healing.

• GP within a week or two: new Raynaud after age 40, or with joint pain, rash or skin tightening.

• Routine GP: long-standing cold hands and feet with no other symptoms.

Doctors ask about colour changes, triggers, smoking, medicines, tiredness, weight change, periods, joint pain, rashes and walking pain. They check pulses at the wrists and ankles, capillaries in the nailfold, skin temperature, the thyroid and blood pressure.

• Blood tests: full blood count, ferritin, thyroid function, glucose, and autoimmune antibodies if Raynaud is suspected to be secondary.

• Nailfold capillaroscopy: helps distinguish primary from secondary Raynaud.

• Ankle-brachial pressure index and arterial Doppler: for peripheral arterial disease.

• Vitamin B12 and kidney tests: where indicated.

Keep the whole body warm, wear layers, gloves, thick socks and warm footwear, and use hand warmers. Stop smoking, since nicotine narrows blood vessels. Reduce caffeine, and exercise regularly. Avoid sudden temperature changes and review medicines with your doctor.

On the NHS, a GP orders blood tests and refers to rheumatology or vascular services. Private rheumatology and vascular consultations with nailfold capillaroscopy and Doppler are available directly.