Frostbite

After exposure to cold, a person may initially notice the symptoms of frostnip, or mild frostbite, which include:

• a prickly sensation, or pins and needles
• mild numbness
• reddened, painful skin

In severe frostbite, a person may notice:

• blisters on the skin
• hard, white skin which is completely numb
• blackened skin, known as gangrene, which means the tissue has died

Anyone who is exposed to extreme cold for a significant length of time has a risk of developing frostbite. Windy weather may contribute to frostbite, too, by blowing body heat away from the body.

Frostbite occurs more often among:

• those who work outside or exercise (such as skiers and runners) in extremely cold areas
• mountain climbers
• people who are caught in the elements without proper clothing
• people taking certain medications, such as beta-blockers, that decrease the blood flow to the skin
• smokers
• people who have blocked arteries, atherosclerosis or other problems that affect blood circulation
• people with diabetes
• people with nerve problems that decrease their ability to feel injuries in certain parts of the body, a condition called neuropathy

Prevention is the key to avoiding frostbite. When a person is in very cold areas for long periods of time, he or she should:

• stop smoking and drinking alcohol
• wear warm, multilayered, dry clothing (cotton is best, as opposed to wool) that fits loosely, as tight clothes tend to be less warming and can cut down circulation. Some materials are designed to wick moisture away from the skin; an important factor in athletes who sweat.
• avoid high altitude, windy areas
• stay warm through activity
• take necessary precautions to prevent cold exposure

If a person should get wet in cold weather, it is important to dry off quickly and change clothes right away.

Usually, a healthcare professional diagnoses frostbite if:

• a person reports exposure to extreme cold and a feeling of pins and needles followed by numbness
• skin in the injured area has a change in color or thickness

If a person may have frostbite, it is important to:

• bring him or her to a warmer spot
• remove any wet or constricting clothing
• thaw the area by putting it into warm water that is less than 110 degrees F for at least 20 minutes, if possible. This thawing may cause the affected person pain or discomfort, but it is important.
• apply gauze dressings to the frostbitten area, if available, wrapping each toe or finger separately
• move the area as little as possible
• try to keep the area warm so that it will not freeze again
• seek medical attention

There are several things to avoid when treating frostbite. A person should not:

• rub or massage the affected area
• break any blisters that are present
• use hot water or direct heat such as hair dryers, radiators or fires to warm the frostbitten areas

A healthcare professional will continue treatment as needed. Pain and infection of the infected skin areas are fairly common problems from the injury. Pain may require prescription-strength pain medications in some cases. Antibiotics may be required for infection, which are usually given topically.

Surgical treatment may be needed in some cases, but is often delayed. This is because most severe cold injury is more superficial than it seems, and often causes less tissue loss than predicted. Sometimes the frostbitten areas are large or severe enough to require a skin graft or even amputation of the affected area.

All medications cause side effects, such as allergic reactions or stomach upset. Surgery can be complicated by infection, bleeding or an allergic reaction to the anesthetic.

After recovery, a person can generally return to normal activities.