Exposure to cold temperatures for prolonged periods of time may directly damage the skin leading to the undesirable and painful frostbite.
Though many may experience frostbite, outdoor workers and recreationalists, the armed forces and the homeless are more likely at risk to suffer from cold injuries.
Frostbite may occur in two ways:
The reduced temperatures may cause direct damage the skin. Indirectly, the cold temperature may lead to constriction of the blood vessels in the skin preventing adequate perfusion. As our skin becomes “thirsty” for nutrients, the skin tissue becomes dead, necrotic and may become red, white and then becomes blue in color.
Classically, the severity of the frostbite injury is directly related to the duration of freezing and the temperature.
Early recognition and prompt treatment is essential to prevent serious consequences, such as amputation.
Before the swelling develops, it is important to cover the affected body part with clothing or with a warm hand or other body surface to maintain a slightly warm temperature.
This initial step of “rewarming” is key to maintain adequate blood circulation to the injured body part.
Once in a warmer environment, it is important to rapidly thaw the affected body part in hot water.
Rapid thawing results in less extensive tissue damage in contrast to slow thawing. Rapid thawing can be considerably painful as the skin flushes, it is recommended to take analgesics (i.e. ibuprofen, acetaminophen) to help alleviate discomfort.
When the affected body part is successfully rewarmed, supportive measures such as bed rest, wound care, avoidance of trauma and a high-protein/high-calorie diet is imperative. Gently massaging the frostbitten body part may be helpful; however, avoid aggressively rubbing, especially if remains numb. Swelling and redness may develop after a few hours after rewarming. Exposing the affected body part to air at room temperature, elevated and slightly flexed may help relieve discomfort and swelling.
Evaluation by a dermatologist and/or your primary care provider is important to evaluate the need for administration of blood thinners (anticoagulants) or the need for oral antibiotics. Recovery from severe frostbite injuries may take months.
Prevention of frostbite is imperative as it may have serious consequences. Wearing appropriate clothing (several layers, gloves, hats, thick lined socks), avoiding immersion of feet in warm or cold water when outdoors in cooler temperatures, limit time outdoors when it is cold, wet and/or windy, and remain hydrated and eat well-balanced meal before going out in the cold (“warm belly”).
Continue to keep moving while outside as exercise can help promote blood flow to your extremities and prevent vasoconstriction. Most importantly, be on high alert for signs of frostbite—numbness, tingling, redness, swelling, pain and paleness of the skin.