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General Medical Questions
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Question : I am 19 years old. I have bluish fingers and purple nail beds and cold hands all the time. What could this be?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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May 15, 2014
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Many people complain of having cold hands, cold feet or both.  But, the combination of color changes in your fingers and cold hands suggests poor blood circulation.  The question is: why?

There are a few ways this can happen. 

Raynaud’s disease is by far the most common cause of a blue or purple discoloration to the fingers and nail beds.  Being exposed to the cold triggers the small blood vessels in the fingers to narrow.  This, in turn, causes the fingers to turn white and then blue.  

Eventually, the blood vessels open up and the fingers become redder than normal before returning to normal.  The entire process may take only a few minutes. But pain, numbness and tingling during that time can be significant.  The narrowing and widening of blood vessels in the fingers is actually a normal process. But for people with Raynaud’s disease, it is exaggerated and more easily triggered.

Severe Raynaud’s disease can be found in people with Scleroderma, Lupus and other diseases in which the immune system “misfires” against its host.  But most people with Raynaud’s disease have none of these conditions.

Here are some other causes of poor circulation in the fingers:

  • Blood clots. But this is unlikely to affect both hands and no other parts of the body.
  • Vasculitis. This is a group of rare diseases that cause blood vessels to become inflamed.
  • Infection (septic shock or sepsis). Bloodstream infections can lower blood pressure so severely that the extremities turn blue. Infections can also interrupt blood flow when the infection actually blocks blood vessels, a phenomenon called ‘septic emboli.’
  • Prolonged exposure to cold temperatures.

Also, an underactive thyroid (hypothyroidism) can cause “cold intolerance” (feeling cold when others are comfortable). And it may be a risk factor for Raynaud’s disease.

Finally, a blue discoloration of your extremities can also be a sign of low oxygen in the blood. In general, the closer to normal your oxygen level is, the redder it is.  Severe lung and heart disease are common causes.  But these conditions would not be expected to cause the temperature changes you describe.

As you can see, there are many possible answers to your question.  Arrange an appointment with your doctor to help identify which one applies to you.

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