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Most people are aware that blue or gray hands often indicate poor circulation. This blueish gray tint is known as cyanosis, and peripheral cyanosis where it exclusively affects the extremities. 

Many different factors can lead to this condition. Here, we will discuss those that pertain to persistently gray hands without clear environmental explanations such as contact with dyes, temporary exposure to extreme cold, or high altitudes. 

Gray Hands: Most Often Caused By Raynaud's Phenomenon

Raynaud's phenomenon is a common condition in which blood flow to specific parts of the body — usually the hands or feet — is temporarily restricted. The affected body parts will first become extremely pale, after which they take on a blue or gray tint. Once blood flow returns, the affected part of your body will become very red. Numbness and pins and needles can also often be felt. 

Raynaud's phenomenon is most commonly triggered by exposure cold temperatures, but can also be the result of stress and even underlying medical conditions such as rheumatoid arthritis. 

Peripheral Arterial Disease (PAD)

Peripheral arterial disease is a condition in which blood flow is limited by a narrowing of the arteries due to the build up of fatty deposits (atherosclerosis). Though PAD most commonly affects the legs, the arms can be affected too. Besides a gray, blue or pale discoloration of the affected area (in this case the hand), symptoms of PAD can include numbness of the area, skin that is cold to the touch, dry, and sometimes shiny, and muscle weakness. Hair loss may occur around the affected area, as well. 

Symptoms develop gradually, and smoking, hypertension, high cholesterol and diabetes are among the main risk factors for PAD. 

Blood Clot (Thrombus) 

A thrombus, or blood clot, in the arm is another potential cause of blue or gray colored skin of one of the hands. This blood clot (partially) blocks blood flow, resulting in tissue damage and the following accompanying symptoms:

  • Pain
  • Pallor
  • A weak pulse
  • (Perishing) cold
  • Paresthesia ("pins and needles")
  • Paralysis 

Blood clots can successfully be treated if they are diagnosed on time, so acting fast is important. 

Acrocyanosis

Acrocyanosis is a rare and benign functional peripheral vascular disorder, once again characterized by persistently blue or gray areas of skin. Most commonly affecting the hands, it can also occur in the feet, areas of the face, and the nipples. Mild cases of acrocyanosis do not require medication, but lifestyle changes such as avoiding cold temperatures will be advised. 

Other Potential Causes Of Gray Hands

Beta blockers, commonly taken for heart disease or hypertension, can have gray or blue hands as a side effect. 

Cyanosis that affects more than just the hands is called central cyanosis. The blue or gray tint is frequently most prominent around the lips in this case. Central cyanosis can point to a wide variety of medical conditions, including chronic obstructive pulmonary disease (COPD), asthma, pneumonia, pertussis, and a pulmonary embolism (blood clot of the lungs). It can also point to heart failure, epiglottitis, or anaphylactic shock. 

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