Cold hands and feet are very common when the weather is cold. Also the natural temperature of our bodies can cause cold hands and feet but also there are some cases when real medical issues are causes for cold hands and feet. Small blood vessels in your hands, problems with blood circulation and number of other medical can lead to cold hands and feet. If you have occasional cold hands and feet, then you should not be worried about it. But if you have persistent cold hands and feet which are associated with changes in the skin color or they are continual, then you can have a problem with the blood circulation or with nerves . Also you may be experiencing tissue damage in your feet and hands. When your hands or feet, and in some cases other parts of your body especially your nose and ears, get too cold, they can be injured or react in different ways. The most severe cold injury is frostbite which is true tissue freezing – ice crystals are forming in your skin and other tissues of your body [2,3]. This condition is causing permanent damage to your blood vessels and other structures. Also there is another common condition which is forming ice crystals known as frostnip but in this condition ice crystals are forming in tissues but only in the very outer layer of your skin.  This condition is not causing permanent damage. Immersion injury results from the exposure of wet feet or wet hands to cold temperatures at or above freezing. This condition develops over hours to days and it damages muscles and nerves. This condition, like frostbite, can cause permanent damage. There are other conditions of cold hands or feet such as cold urticaria, cryoglobulin formation, Raynaud’s phenomenon and pernio.
Diseases that can trigger cold hands and feet
There are many different diseases which could lead to cold hands and feet. Here are the most common diseases that could lead to cold hands and feet:
- Frostbite and frostnip: [2,3]
- Frostnipped parts are white but not hard and are generally very small areas
- Frostbitten body parts are white and hard or waxy. They may be white – yellow or white – purple.
- Frozen parts have no feeling.
- During the freezing process, frozen parts may feel like a block of wood or they may tingle.
- Once frostbitten areas thaw, they may be tingle or painless.
- It is very recommended method to be rapidly rewarmed in warm water, they may be painful.
- Over the next few days, the part is swollen and painful
- Blisters can also appear and severely affected areas turn black
- Cold urticaria: This refers to raised red bumps or hives which are produces in response to cold exposure. 
- Anemia: This condition often causes extreme pale skin weakness, fatigue and cold hands and feet. The iron deficiency anemia often goes undiagnosed until the person experience Raynaud’s disease. If you have noticed that your hands and feet stay cold despite warming measures, then you should check your iron levels. 
- Pernio is a rash on the ears, hands, toes, feet or lower leg that may be blue or red and may form lumps or scaly areas
- There are rare cases when the affected parts may blister, bleed or have skin breakdown
- Often pernio causes burning and itching
- Cryoglobulins: This condition causes a wide array of symptoms, depending on the whether or not internal organs are involved in which is included deep – blue fingertips.
- Diabetes: This disease can cause different types of problems in which are included cold hands and feet due to circulatory problems, thyroid problems and high blood pressure. 
- Immersion injury :
- Areas which are affected by this condition are first red and then they turn pale and swollen
- Painful tingling or numbness may occur
- After the first few days, the part becomes swollen, tingling and very red, and may have skin breakdown, blisters or even liquefy
- Raynaud’s phenomenon: This condition refers to constriction of the blood vessels of the feet or hands in response to cold exposure. This condition causes white, then blue, then red – colored fingertips and toes and often this condition is painful. 
 Bae KH, Jeong YS, Go HY, et al. The definition and diagnosis of cold hypersensitivity in the hands and feet: Finding from the experts survey. Integrative Medicine Research. 2018;7(1):61-7.
 Cheung SS. Responses of the hands and feet to cold exposure. Temperature (Austin). 2015;2(1):105–20.
 Heil K, Thomas R, Robertson G, et al. Freezing and non-freezing cold weather injuries: a systematic review. British Medical Bulletin. 2016;117(1):79-93.
 Stepaniuk P, Vostretsova K, Kanina A. Review of cold-induced urticaria characteristics, diagnosis and management in a Western Canadian allergy practice. Allergy, Asthma & Clinical Immunology. 2018;14.
 Bae KH, Go HY, Park KH, et al. The association between cold hypersensitivity in the hands and feet and chronic disease: results of a multicentre study. BMC Complementary Medicine and Therapies. 2018;18:40.
 Temprano KK. A review of Raynaud’s disease. Mossouri Medicine. 2016;113(2):123–6.