What causes numb and white, blue or red fingers?

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Published: July 8, 2013
Last reviewed: January 13, 2017

WHITE and Numb Fingertips

  • In sensitive individuals, after brief exposure to cold (within seconds) or during stress, one or more fingertips on one or both sides become pale and numb and then blue and then red; the attack may last from several minutes to hours (Raynaud’s phenomenon or syndrome).
  • Repeated use of vibration tools, such as hammerjack, may cause vibration white finger or hand-arm vibration syndrome (HAVS) with occasional numbness in the fingertips, which may become permanent with time; fingertip discoloration does not occur during vibration but after exposure to cold or stress (Raynaud’s phenomenon–see above) 1.
  • Within 24 hours of using the hand as a hammer, the 3rd, 4th and 5th finger (or only one or two of them) and related part of the palm may suddenly become white or bluish, numb, cold and painful due to damage of the ulnar artery and nerve; the condition, which is known as hypothenar hand syndrome, may eventually improve; cold sensitivity may persist 2.
  •  Frostnip. After prolonged exposure (minutes to hours) to cold, the hands and fingers may become cold, pale (fingertips may become cyanotic), stiff and, possibly, numb and tingly; reheating may trigger annoying pain in the nail beds 3.
  • Second-degree frostbiteAfter prolonged exposure to severe cold (hours, but can be minutes), the fingertips may become firm (“wooden”), waxy white, with eventual blisters developing 12-24 hours after the cold exposure; there is loss of sensation for touch and, to some extent, for pain 6.
  • Third-degree burn or scald. After contact with hot objects, water vapours, the fingertips may become white with a leathery appearance and transient or permanent loss of sensation to touch and pain 4.
  • In arterial embolism, one or more fingers suddenly become cold, pale or blue, painful, weak, numb or tingly. Cramps may appear and the finger may be hard to move. If not treated promptly, ulcers or gangrene can develop 5.

Raynaud's Syndrome Photo

Picture 1. Raynaud phenomenon
First phase of the attack: white fingers
Second phase: blue fingers
(source: Wikimedia, Creative Commons Licence)

Vibration white finger photo

Picture 2. Vibration white finger
due to working with hammerjack
(source: cdc.gov, Public Domain)

RED Fingertips

  • Contact with the stinging nettle leaves or stems usually causes burning, itchy, red patches (hives, urticaria); numbness may persist for more than 12 hours 7,8.
  • In sensitive people, contact with poison ivy, oak or sumac can cause allergic reaction with red, burning, itchy and swollen skin; numbness and tingling may persist for several hours 9,10.
  • Deep second-degree burn or scald. After contact with a hot object, liquid or vapours, the affected fingertips are usually red and tender, but can later become more or less numb and remain so for up to a month 11,12.
  • Chilblains (pernio). In sensitive people, exposure of the fingers to nonfreezing temperatures below 60 °F (60 °C) and subsequent reheating may result in red or violaceous, blistering, itchy, tingly and numb fingertips or toes. Numbness usually goes away in one to three weeks or may persist for years 6,13.
  • minor cut or puncture of the fingertip can result in felon or staphylococcal whitlow — an infection with red, swollen, painful and, eventually, numb fingertip pulp 14,15.
  • Stings of venomous insects, such as a bee, wasp, hornet, spider (black widow, brown recluse spider) and scorpion, can cause burning pain, redness, blisters and swelling in the affected fingertip, followed by tingling and numbness, which may persist for a day or two 16,17,18.
  • Bites of non-venomous insects, such as mosquito, horse fly, flea, scabies mites, bed bugs, lice, ticks, chiggers and cockroaches, can cause itchy red bumps, sometimes followed by tingling and numbness 19NOTE: The exact site of the insect bite may not be always seen.
  • Bites of poisonous snakes, such as cobra or rattlesnake, to the arm can cause numbness and tingling in the affected area spreading toward the fingertips 20.
  • Vasculitis:
    • In rheumatoid vasculitis (in rheumatoid arthritis and systemic lupus erythematosus or SLE), numbness and pits in the fingertips and red sores around the nails may develop 21,22.
    • Symptoms of Churg-Strauss syndrome may include difficulty breathing (asthma), and red-bluish and numb fingertips 23.
  • One side effect of certain chemotherapeutics is hand-foot syndrome (acral erythema or palmar-plantar erythrodysesthesia) with numbness, tingling, pain, redness, swelling or flaking of the palms, fingers, soles and toes.

Chilblains on the fingers photo

Picture 3. Chilblains
Red, swollen fingertips with big blisters
(source: Wikimedia, Creative Commons Licence)

PINK Fingers

  • Poisoning with elemental (metal) mercury in children: pink, numb or painful fingers, peeling hands and leg cramps (acrodynia) 24.

BLUE or PURPLE Fingertips

  • After an injury, for example, with a hammer, the affected fingertip usually becomes tender and bruised: red, then  swollen and partially numb then dark blue-purple and then yellow-green.
  • Achenbach syndrome (paroxysmal hand hematoma, finger apoplexia) 25 consists of sudden pain, itching, stinging, swelling, coolness, bruising and, sometimes, numbness on the palmar side of one or, rarely, more fingers that last for few days and then resolve spontaneously; this benign condition is due to spontaneous bleeding in the finger. Triggers include physical work with hands, minor trauma, exposure to cold. The affected individuals often have Raynaud’s phenomenon, migraine, chronic venous insufficiency (varicose veins), gallbladder disease, allergies or a blood disorder, such as anemia or thrombophilia. The condition may run in families. Blood and other tests are usually normal.

Cyanosis

Cyanosis means bluish discoloration of the skin due to lack of oxygen in the tissues.

Peripheral Cyanosis

In peripheral cyanosis, fingers and toes, especially nail beds, and, sometimes, the skin around the mouth (circumoral cyanosis), but NOT lips and tongue, become bluish 26.

Peripheral cyanosis is caused by impaired circulation in the limbs:

Acute (sudden) peripheral cyanosis can be caused by 26:

  • Cold injuries: hypothermia due to prolonged immersion in cold water or exposure to cold air 27,29, chilblains 28, deep frostbite (persistent cyanosis and numbness after rewarming are bad prognostic signs) 30.
  • Raynaud’s phenomenon–see above under white fingertips.
  • The “acute blue finger” or “blue finger syndrome” 31. Some individuals experience sudden blue discoloration, coolness, swelling, pain (not always), numbness or “pins and needles” in one or more fingers without apparent reason. Symptoms may last for few days and rarely recur. Possible risk factors include smoking, atherosclerosis, Raynaud’s phenomenon, trauma, frostbite, thoracic outlet syndrome, cryoglobulinemia, polycythemia. The condition is often benign and the risk of thrombosis or embolism is low.
  • Prolonged seizures (tonic-clonic seizures or grand mal epilepsy) 32
  • Acute artery narrowing due to an embolus (due to atrial fibrillation, thoracic outlet syndrome) or crush injury results in sudden pain, and cool, pale and, later, blue-purple fingers 33.
  • Hypovolemic shock (due to severe dehydration, bleeding or diarrhea) or cardiogenic shock (due to heart attack, arrhythmia)
  • Pheochromocytoma: cyanosis and tingling in the fingertips, finger tremor, pale skin, anxiety, high blood pressure 34
  • Drugs: beta-blockers, methysergide, ergotamine, epinephrine and other drugs can increase the risk of Raynaud’s phenomenon with white, blue and red fingertips 35.

Chronic (persistent) peripheral cyanosis may be caused by 36,37:

  • Acrocyanosis — persistent bluish-purple discoloration of the fingertips (and sometimes, hands, feet, knees, nose, lips and nipples). Cyanosis is aggravated by cold or stress or by hanging hands down. There are no attacks, and cyanosis persists after rewarming. Other symptoms may include numbness in the fingertips, and cool and sweaty palms. This benign condition, which tends to improve with time, is frequently seen in young women with anorexia nervosa; other causes include ovarian cancer, Hodgkin lymphoma, cryoglobulinemia, hypoxemia low oxygenation of the blood) 38. The risk of arterial occlusion or skin ulcers is not increased. In newborns, acrocyanosis is usually caused by metabolic disorders.
  • Atherosclerosis (mainly in older smokers and diabetics and those with high blood pressure and high blood cholesterol)
  • Venous thoracic outlet syndrome
  • Vasculitis, for example, Buerger’s disease 39 and rheumatoid vasculitis 40
  • Cryoglobulinemia–abnormal blood proteins causing blood clotting–, for example in hepatitis C 41
  • Congestive heart failure
  • Deep vein thrombosis or arterial thrombosis 42

Central Cyanosis

In central cyanosis, hands and feet, especially nail beds, lips, gums and tongue have bluish discoloration, but are not cold (unless the causes of peripheral cyanosis are present) 26.

Central cyanosis is caused by decreased oxygenation of the blood:

Acute (sudden) central cyanosis 26:

  • Lack of oxygen in the air (hypoxia) in high altitudes (climbers, pilots) 43
  • Respiratory disorders: croup, whooping cough (pertussis), epiglottitis, bronchiolitis, severe attack of asthma, aspiration of vomitus, severe pneumonia, pulmonary edema, pulmonary embolism, tension pneumothorax, acute respiratory distress syndrome  (ARDS)
  • Heart disorders: heart attack, arrhythmia
  • Methemoglobinemia: ingestion of or skin exposure to aniline, benzocaine, dapsone, pyridium, nitrites, nitrates, naphthalene, primaquine
  • Sulfhemoglobinemia: overdose of certain drugs (acetanilide, metoclopramide, nitrates, phenacetin, phenazopyridine, sulfasalazine, sulfonamides), ingestion of household cleansers (hydroxylamine sulfate) 26,44.
  • Disseminated intravascular coagulation (DIC), for example, in sepsis (see more causes below under Gangrene).
  • Poisoning: solvents (chlorobenzene), pesticides (arsenic, strychnine, organophosphates) 45

Chronic (persistent) central cyanosis 26:

  • Heart disorders: congenital disorders, cardiomyopathy, heart valve disease (infectious endocarditis, rheumatic fever, hypertension, aortic aneurysm) 42
  • Respiratory disorders: chronic obstructive pulmonary disease or COPD (bronchitis, emphysema), bronchiectasis, pulmonary fibrosis, cystic fibrosis
  • Severe anemia
  • Blood hyperviscosity: Waldenström macroglobulinemia, polycythemia vera, multiple myeloma, leukemia, thrombocythemia, paraneoplastic syndrome in certain cancers 47
  • Obstructive sleep apnea
  • Genetic methemoglobinemia

Blue fingers, cyanosis photo

Picture 4. Cyanosis
Blue fingertips and hand due to lack of oxygen in the blood
(source: Wikimedia, Creative Commons Licence)

BLACK Fingertips

  • In the third-degree frostbite, the affected fingertips become bluish-greyish or black and numb; superficial layers may peel of. Ulcers and eventual permanent decrease of the fingertip sensitivity may develop 6,13.
  • In the fourth-degree frostbite, gangrene (tissue death) can occur, especially after freeze-thaw-refreeze situation 6,13.
  • In the fourth-degree burn, the fingertips carbonize and eventually crumble and fall off 4.

Gangrene

Gangrene means tissue death (necrosis); it is caused by blocked circulation, bacterial infection or trauma 48.

Dry Gangrene

Dry gangrene can develop in severe atherosclerosis (in diabetes), vasculitis (for example, in Buerger’s disease), scleroderma or severe Raynaud’s disease 49.

Symptoms of dry gangrene: the affected fingertip becomes red, then pale, cold and numb, then brown, purple or black, it shrivels up and eventually fall off  48,51.

Wet Gangrene

Wet gangrene can occur due to bacterial infection in severe frostbite, burn or injury.

Symptoms of wet gangrene: painful, swollen fingertips with foul smelling discharge; the fingertips crumbles and eventually falls off (autoamputation) 48,51.

ACUTE gangrene of the fingertips 46,49,50:

  • Tight wound dressing or splint immobilization of the finger 52
  • Fourth-degree frostbite 6,13third- and fourth-degree burn 4, electrical injury 53, irradiation injury (>5,000 rads)
  • Severe injury of the finger, hand or arm 55, a cut of radial artery 56
  • Artery occlusion after surgical artery ligation 46, a complication of surgery wound infection 57
  • Infections: felon (cellulitis of the fingertip) 58, cellulitis of the hand 46, necrotizing fasciitis 59
  • Prolonged contact with caustic potash, nitric, or sulfuric acid 46,60. Spilling of diluted (1%) phenol (carbolic acid) solution over the skin can initially cause numbness and tingling followed by skin necrosis 61.
  • Blood clot (thrombus) in deep venous thrombosis 62,63
  • Hypersensitivity angiitis 50
  • Necrotizing vasculitis: rheumatoid vasculitis, polyarteritis nodosa, Buerger’s disease 39,46
  • Plague 64
  • Disseminated intravascular coagulation (DIC) due to sepsis, leukemia, malaria, viral gastroenteritis, snake bites, transfusion reactions, recreational drugs, etc. can cause symmetrical peripheral gangrene affecting the fingertips and toes on both sides 65,66,67,68.
  • Gangrenous ergotism (ergotamine, rarely: infected rye bread) 46,69,70
  • A complication of chemotherapy (for example, the combination of bleomycin and methotrexate) 71
  • Warfarin induced skin necrosis 72.

Black fingers, gangrene, plague photo

Picture 5. Gangrene of the fingertips in plague due to sepsis
(source: cdc.gov)

CHRONIC causes of gangrene of the fingertips 46,49,50:

  • Hyperglycemia in long-term, poorly controlled diabetes 1 or 2 46
  • Arteriosclerosis (in older people, smokers, those with high cholesterol), eventually complicated by emboli lodged in the finger arteries 42,46
  • Vasculitis: polyarteritis nodosa 73, Churg-Strauss syndrome (allergic vasculitis) 23,74, microscopic polyangiitis 75, rheumatoid vasculitis (SLE, rheumatoid arthritis) 76, Buerger’s disease (in heavy smokers) 39
  • Hypereosinophilic syndrome 77
  • Severe Raynaud’s phenomenon associated with scleroderma (CREST syndrome) or lupus 50,78
  • Chronic disseminated intravascular coagulation (DIC) as a complication of ulcerative colitis, Crohn’s disease, leukemia, cancer, sarcoidosis, retained dead fetus syndrome 79
  • Cryoglobulinemia, for example, in hepatitis C 41
  • Antiphospholipid syndrome (APS), which may be associated with systemic lupus erythematosus (SLE) or other rheumatic disease 80
  • Angio-sclerotic gangrene 46
  • Thrombotic thrombocytopenic purpura (TTP) 72

6 Responses to What causes numb and white, blue or red fingers?

  1. J says:

    Dear Sir,
    I have got servere pain on my thumb tip and can see blue colour on the tip. Kindly guide vme what could it be and any treatment or precautions I can take.
    Thanks for your co-operation.

    • Staff says:

      Hi. If it is diffuse and permanent bluish discoloration lasting for more than few days, it’s probably due to impaired blood flow, which is usually caused by atherosclerosis or a clot lodged in the thumb artery. I strongly recommend you to visit a doctor to get correct diagnosis and treatment. So, if it is impaired blood flow, it is not likely you will be able to cure it by yourself by some sort of remedy.

  2. Rebecca says:

    My husband fell and injured his elbow.he may have tore or broke it. His hands are swollen and fingers are turning blue. Je doesnt want to see his doctor because hes a stroke patient and doesnt want his doctor to know he drinks or does cocaine.why are his finger blue?

    • Jan Modric says:

      Rebecca, this sounds as an urgent medical condition to me. If he does not get treatment soon, he may lose the fingers. The fingers can be blue because they do not get enough blood.

  3. Mark Macdonald says:

    Had a very bad cold for over a week now which is nothing new but I’m starting to get pins and needles in my right thumb and the whole thumb turns white ( very pale ) didn’t think nothing of it at first but this happens quite a few times now , went doctors for my cold and the thumb went again in front of the doctor who said it was strange but did nothing , what the hell could this be ?

    • Jan Modric says:

      Mark, if this will continue I suggest you to insist in getting the exact diagnosis. The white color is obviously related to a circulation problem, such as Raynaud’s phenomenon or an embolus, for example.

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