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Frostbite

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Frostbite

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When the skin gets exposed to extremely cold temperatures, frostbite occurs. Detailed information is given in the article below.

Medically reviewed by

Dr. Anshul Varshney

Published At January 8, 2019
Reviewed AtNovember 1, 2023

Introduction:

When a person’s skin is exposed to an extremely cold atmosphere, the skin starts showing signs of tissue damage, this tissue damage due to cold exposure is known as frostbite. Frostbite is also called a cold injury. Frostbite can be usually seen under circumstances where the temperature is below zero degrees Celsius. Protecting the skin against exposure to cold temperatures with appropriate clothing such as warm clothes can help avoid frostbite.

Prolonged exposure has to be avoided always. Patients who experience frostbite are at higher risk of ischemic injury (an injury caused by restricted oxygen and blood supply) of tissues and necrosis (tissue death due to injury or failed blood supply). When the body experiences an intense amount of cold, the process of vasoconstriction (narrowing of blood vessels) starts. Then, the skin tissues are deprived of heat and adequate blood supply, eventually, ice crystals start forming in the tissues. That is why it is also cold as cold burns on skin.

What Is a Frostbite?

Frostbite is a condition in which skin tissue death is caused by exposure to extremely cold temperatures. A person who does not have adequate means to protect the skin against such a low temperature may suffer frostbite. Whenever the skin of a person stays exposed for a prolonged time to an extremely cold temperature generally below zero degrees Celsius, eventually suffers frostbite. The skin tissues need sufficient blood and oxygen supply to keep themselves alive. When this supply cycle is disrupted due to vasoconstriction that is the narrowing of blood vessels, and the blood supply is slowed down or restricted, then the tissue starts losing its viability. When tissue death occurs, frostbite takes place. The heat along with the oxygen and blood does not reach the tissues and thus, ice crystals start forming at the place of the tissues. The body parts that are more susceptible to frostbite are the face, lips, hands, feet, and ears. Frostbite cases can be seen mostly in winter and among homeless people as they cannot protect themselves from extreme cold weather. Frostbite can be dangerous if not treated as soon as it appears.

In What Stages Does the Frostbite Occur?

Frostbite occurs in different stages explained and different classifications are also given in the following:

  • Frostnip: The skin gets sore, and cold and the person can feel a certain amount of pain.

  • Surface or Superficial Frostbite: In this stage, the pins and needles sensation occurs and slight changes in the color of the skin can also be seen. If this stage is treated then a fluid-filled blister can appear for two to three days on the skin.

  • Deep Frostbite: This is the severe stage of frostbite. It affects all the layers of the skin, the color changes to a whitish tone or bluish-gray tone. The person loses the sensation and eventually the frostbitten area turns black as the tissue dies completely.

The following classification is given according to grades:

  • Grade I: There is no risk of cyanosis (bluish discoloration of the skin due to lack of oxygen) and amputation (surgical removal of the extremity) is not needed.

  • Grade II: Cyanosis can be seen at the end of the extremities and amputation of the soft tissue may need to be done.

  • Grade III: Cyanosis starts spreading and is in an intermediate state, amputation of the affected digits of the affected extremity may need to be done.

  • Grade IV: The entire tissue dies and turns black, amputation of the entire affected area has to be done in this stage.

The following classification is based on degrees of frostbite:

  • First Degree: Central pallor (skin loses its original color and shows whitish tone), numbness, surrounding erythema (surface of the skin turns red) or edema (swelling caused by fluid saturation), desquamation (loss of skin tissue in the form of scaling, peeling or shedding), dysesthesia (an abnormal sensation felt after a touch usually happens due to peripheral nerve damage.)

  • Second Degree: Skin blistering with surrounding edema or erythema.

  • Third Degree: Tissue loss concerning the entire thickness of skin, hemorrhagic (bleeding) blisters

  • Fourth Degree: Tissue loss affects deeper structures, resulting in the loss of the involved part.

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How Is Frostbite Diagnosed?

A healthcare provider will diagnose frostbite after a thorough physical exam and potential imaging tests. During the exam, the healthcare provider will look for skin discoloration or other skin symptoms like blisters or mottling (marks or smears of color). The provider will ask the patient questions about the cold exposure. Depending on the severity of the symptoms, the healthcare authority may take an imaging test such as an X-ray to look under the skin for tissue damage. Tools like the frostbite calculator can be used by people prone to frostbite.

What Is the Treatment and Management of the Frostbite?

  • Further injury by covering the exposed areas has to be avoided. The care of patients with frostbite initiates with rewarming in the affected area if there is no uncertainty of refreezing, as thawing or refreezing can worsen injuries. Patients should be avoided from the cold wind.

  • The wet clothing should be removed and replaced with dry clothing. Vigorous rubbing has to be avoided as this can cause further damage.

  • Patients with full-thickness injuries with evidence of ischemia and no restoration of tissue perfusion after rewarming may be candidates for thrombolytic (tPA) therapy (the use of medications to destroy blood clots or prevent new blood clots from forming.). Thrombolytic therapy (tPA) may lessen the need for digital amputation (the surgical removal of a portion of a finger). Combination therapy with tPA (Thrombolytic therapy is a strong clot-dissolving medication, intravenously given, that liquefies the blood clot and reconstitutes the blood flow and oxygen to the brain.) and IV (intravenous) heparin may also lower the necessity for digital amputation. A potent vasodilator holds the potential treatment to avert ischemia in frostbite.

Conclusion:

Frostbite can lead to death if not treated at a proper time with appropriate means. It may form small blood clots in the blood vessels leading to disrupted blood flow to the organs. Cardiac collapse can also occur which can be fatal. Sepsis (an extreme stage of infection) can be seen in various cases of frostbite, which has the potential to kill the patient. If slurred speech, loss of coordination, and intense shivering occur then the patient should seek emergency help. Time is an important factor while treating frostbite along with an appropriate treatment. Frostbite can lead to many functional changes in the organs of the body later in the life of a person. Thus, it is important to prevent this condition.

Frequently Asked Questions

1.

Will Frostbite Heal?

For frostbite to heal completely, the tissue has to be free from any infection or damage. It might take up to three months for the removal of the dead tissues. The patient should be kept under observation for three months.

2.

Will Frostbite Hurt?

When the frostbite begins to progress, it will start affecting all three layers of the skin. The skin begins to turn whitish or grayish in color. The patient will have extreme numbness and pain in the affected area.

3.

How Long Will Frostbite Take to Heal?

The time for frostbite to heal depends on the tissue damage and its severity. If there are other infections, then the frostbite will take a long time to heal. In some patients, it might take up to three months for the complete tissue damage to heal.

4.

Why Does Frostbite Turn Blackish?

The skin will turn bluish or black in cases of severe frostbite. If the injured area is warmed, it will develop into big blisters within one or two days. This area later transforms into dark skin because of the tissue death in that area.

5.

Is Frostbite Damage Permanent?

Frostbite does not cause any permanent damage. First-aids measures are beneficial for treatment for frostbite. If the frostbite occurs only on the superficial layer of the skin, then the complete recovery is possible.

6.

How Does Frostbite Feel Like?

Frostbite occurs when the skin experiences extreme cold. Cold conditions make the skin feel numb and pale. Some patients experience pricking sensation. There will be a reduced feel for touch. Blister formation will be painful for the patients.

7.

When Should I Be Worried About Frostbite?

You need not worry about frostbite if you are adapted to cold weather. If you suddenly experience abnormal symptoms like reddish skin or swelling, then you might need emergency medical care.

8.

Can Your Fingers Fall off From the Condition of Frostbite?

There will be a certain degree of tissue loss in cases of severe frostbite patients. The tips of the toes and fingers can be completely lost due to untreated frostbite. The finger can separate and fall off in some patients.

9.

How Long Will It Take For Frostbite to Turn Black?

The skin will turn into black only after the formation of blisters. It might take around 24-48 hours for the skin to become dark in color. This happens only in the part of the skin that has been rewarmed.

10.

What to Do If Frostbite Occurs?

The following things are to be followed for frostbite.
- Initially, it is necessary to check the body temperature. A very low temperature will be a complication.
- You have to protect your skin from severe damage.
- Stay away from the cold.
- Gently rewarm frostbitten areas.
- Drink warm liquids.
- Consider taking medications for pain.

11.

What Are the Long Term Effects of Frostbite?

After having frostbite, certain people are left with permanent issues, such as increased sensitivity to cold, stiffness, pain, and numbness in the affected area. However, not much can be done to treat numbness, sensitivity to cold, or stiffness.

12.

What Should You Not Do When You Have Frostbite?

Below steps must not be followed when you have frostbite. They are:
- Avoid moving or roaming to cold areas.
- Avoid walking with frostbitten toes and feet as it can cause excess damage.
- Avoid wet clothing. It is better to replace wet clothing with soft and dry clothing to stop further heat loss.

13.

Which Degree Is Deep Frostbite?

Deep frostbite is the third degree of frostbite. It is the most severe stage of frostbite. It is known to affect both the underlying skin tissues. The part of the skin which has deep frostbite might appear bluish. The skin would have become numb, and it would not have any sensation to the pain and cold.

14.

What Are the Different Stages of Frostbite?

The occurrence of frostbite happens in the following stages.
- Frostnip. This is a mild form of frostbite.
- Superficial frostbite. It appears as reddened skin that turns pale or white.
- Deep frostbite (severe). As frostbite grows, it affects all skin layers, including the tissues that are below.

15.

What Are the Home Remedies?

For milder frostbite cases, consume over-the-counter drugs like Ibuprofen. It can help reduce inflammation and pain. For superficial frostbite that has been rewarmed, some people find it soothing to apply lotion or aloe vera gel to the affected area numerous times a day. Better to avoid further exposure to wind and cold climate.

16.

What Does the Frostbite Look Like Initially?

Frostbite affects superficial layers of the skin initially. It causes reddish appearances of the skin. It will later turn into pale and white form. Rewarming of the skin at this stage can cause mottling of the skin. It may be accompanied by swelling and a burning sensation.

17.

What Happens If Frostbite Goes Untreated?

If the frostbite is left untreated, then the skin is known to become very hard. It would also turn reddish or purplish with a mottled appearance. This is known to happen within three days. Sometimes, blister formation will occur along with the filling up of fluid.

18.

Can Frostbite Have Long Term Effects?

The long term effects of frostbite are abnormal sensitivity to cold. This will be seen along with the stiffness and numbness in the affected areas. Pain caused due to long term effects of frostbite will be high. In some cases, it becomes difficult to treat frostbite.

19.

When Should I Be Worried About Frostbite?

You need not be worried unless you detect some extreme symptoms. If you notice blister formation and the swelling, then this is the time you must visit the doctor immediately.

20.

What to Do If Frostbite Occurs?

A mild degree of frostbite can be treated with necessary home remedies. The affected part of the skin should be soaked in warm water for about half an hour. Rubbing or massaging the frozen area of the skin should be avoided. If all these techniques do not help, you can consult a doctor for further treatment procedures.

21.

Is Frostbite Damage Reversible?

We can identify whether frostbite is reversible or irreversible by determining the degree of cellular damage and extent of the skin's damaged region. In most cases, frostbite reverses itself after giving a warm water bath. It is not helpful, and then you should proceed to reverse the ice-crystal formation in superficial frostbite. You should seek a doctor's help for this.
Dr. Anshul Varshney
Dr. Anshul Varshney

Internal Medicine

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