The best strategy is prevention
Frostbite is a term that is used when skin is severely damaged by the cold. The skin and underlying tissues freeze and secondary injury occurs. As the skin freezes it becomes red, then numb, then solid/firm and finally pale.
Frostbite can occur anywhere on the body including areas that are covered and protected, but typically it happens in the extremities and regions commonly exposed to the cold and wind such as fingers, toes, nose, ears, cheeks and ears.
Frostbite is an injury where the skin actually freezes. In severe cases, the underlying tissue can be affected, too. First, your skin becomes painful and tingles. Next, the skin becomes very cold and red, then numb, hard and pale.
Sometimes, in severe cases, hands are difficult to close, or joints underlying the frostbite will be difficult to move. Exposed skin in cold, windy weather is most vulnerable to frostbite. But frostbite can occur on skin that is covered. Because the area that gets frostbitten often becomes numb, a sufferer may not even realize it until someone else points it out to them.
Frostbite commonly occurs upon exposure to cold weather, but it can also be caused by exposure to cold metals, ice or cold liquids.
In cold weather, one must be cautious and protective by wearing the appropriate clothing and covering vulnerable areas such as hands, ears and face. Temperatures below zero degrees Fahrenheit are especially concerning. Exposed skin can become frostbitten with just 10 minutes of exposure under these conditions.
Very early, mild frostbite is called “frostnip” and only requires rewarming. Other stages of frostbite need medical attention because severe damage can occur such as damage to muscles nerves and bone, and severe blistering can result in infection.
Stages of frostbite
Frostnip: Frostnip is the early, first stage of frostbite. The skin becomes tingly, red and painful. At this point, getting out of the cold and rewarming the skin is all that is required. The skin may become tingly again upon rewarming.
Superficial frostbite: In the second stage of frostbite, the red skin becomes pale or white/light. If the skin begins to have a burning sensation, this is an indication of severe skin involvement. The skin should be rewarmed, but as it warms it may become mottled in color, painful and swollen. Blistering can occur within 12-36 hours after exposure.
Severe (deep) frostbite: If the frostbite continues, it can affect the full thickness of the skin and nerves and the area beneath the skin including fat, muscles, bones and joints. A signal that this is happening is that one loses all sensation of discomfort, coldness or pain in the area(s).
If you experience any signs of frostbite including discoloration, pain, swelling or blistering, consult your physician. In addition to frostbite, the person should also be aware of developing hypothermia. That is where the cold overwhelms the body’s ability to maintain its temperature.
Signs of hypothermia
- Unstoppable shivering
- Thick and slurred speech
- Fatigue and sleepiness
Frostbite risk factors
- Poor circulation
- Infants and children
- Drug and/or alcohol abuse
- Tobacco users
- High altitudes (decreases oxygen to skin)
- Medical conditions that affect ability to feel cold or interfere with normal blood circulation such as diabetes
Frostbite prevention tips
- Check the forecast and plan your outdoor activities appropriately.
- Limit the time you spend outside by employing several warming periods.
- Dress in layers with material designed to both wick wetness away and maximize protection against the cold.
- Cover your head, ears included.
- Limit alcohol consumption.
- Don’t become overly exhausted or dehydrated.
- If traveling extensively in cold areas, have an emergency kit with supplies and warming materials.
- Consider self-warming packs for hands and feet (available at sporting goods stores and online).
- Don’t forget excellent gloves or mittens and thick warm socks.
Continuing skin discoloration, swelling, pain and blistering are all signs of frostbite. Consult your doctor. Depending on the severity, the physician may order other tests to determine if any hypothermia, muscle or bone involvement is present.
Treatment: first aid and medical treatment
For frostnip, gentle rewarming is all that is required. For moderate to severe frostbite, or if hypothermia is suspected, get medical attention right away.
With frostbite, the gentle rewarming should include ONLY lukewarm water warming or a gentle warm bath only. Using other measures can cause burns. If the feet have been severely affected, avoid walking on them because this can cause further damage.
If blisters are present, do not break them. The first step is to immediately get out of the cold; rewarm using water at a temperature of 99-105 F; use an over-the-counter anti-inflammatory such as ibuprofen, Aleve or Advil; and get medical attention immediately.
If the case of frostbite is severe, the doctor may prescribe medications to prevent infection, increase blood flow to the affected areas, reduce pain or increase oxygen flow to the involved areas. Surgical treatment may also be needed.
Remember, when it comes to frostbite, prevention is the best strategy. If you do find yourself in a position of getting frostbite, get out of the cold, gently rewarm, and get medical attention without delay.
Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.