Common Medical Conditions

Frostbite

Written by Dr. K Sneha and medically reviewed by Anshul Varshney

 
Image: Frostbite

Contents


What is Frostbite ?

Injury to the skin caused by exposure to extreme cold is called frostbite. This happens when you are exposed to temperatures below the freezing point of your skin. Exposed skin in cold and windy weather is most susceptible to frostbite, but it can also occur on skin covered by clothing. They commonly affect the body parts that are farther away from the heart, meaning the parts that have less blood flow, like feet, toes, nose, ears, cheeks, chin, hands and fingers. Cold exposure might cause the top layer of the skin to freeze. The skin becomes very cold, red, numb, hard, and pale. Frostbites require immediate medical attention, as it can damage the underlying tissues, muscles, and bones. Severe frostbite may also cause infection and nerve damage. A milder form of frostbite called frostnip does not cause permanent skin damage and can be treated with first-aid measures and rewarming the affected skin.

Causes:

In icy conditions, the body sends signals to the blood vessels in the extremities to constrict and slow the blood flow to them. This makes the body able to carry more blood and oxygen to the vital organs of the body and prevent further decrease in body temperature. When the brain senses that there is a danger of hypothermia, the blood vessels in the arms and legs stay constricted, thus preventing them from pumping cold blood to the internal organs. This is the beginning of frostbite.

It can be a result of either:

  • Ice crystal formation in the spaces between the cells and loss of water from inside the cells, causing dehydration and destruction of the cells.
  • Damage to the blood vessels lining by cold, causes blood to leak out and small clots form in the extremities. This causes inflammation and further tissue damage.
  • Sometimes, the inside of the cells freeze. Most commonly seen in rapid freezing injuries.

Symptoms:

The signs and symptoms are:

  • Cold skin.
  • Prickling feeling.
  • The skin turns red, white, blue, or grayish-yellow.
  • The skin becomes hard and waxy.
  • The joint and muscle stiffen causing clumsiness.
  • Blisters are seen after rewarming the skin.

As the cold causes skin to go numb, you might not realize you have frostbite until someone tells you.

Risk Factors:

The risk factors are as follows:

  • Conditions like dehydration, diabetes, excessive sweating, exhaustion, and poor blood circulation can affect one’s ability to feel or respond to cold.
  • Alcoholism and drug abuse make the body lose heat faster.
  • Smoking.
  • Mental conditions that hamper one’s ability to respond to cold.
  • History of cold injury.
  • Older adults and infants, as they cannot retain their body heat.
  • People in high altitude, as oxygen supply to the body is less.

Complications:

The complications that follow frostbite are:

  • Persistent numbness of the affected areas.
  • Increases the chances of future frostbites.
  • Increased cold sensitivity.
  • A permanent change in skin color.
  • Loss of nail.
  • Frostbite arthritis (joints become stiff).
  • If the frostbite damages the bone’s growth plate in children, growth defects occur.
  • Infection.
  • Tetanus.
  • The death of tissues can cause gangrene.
  • Hypothermia.

Prevention:

Frostbite can be prevented by following these measures:

  • Limit the time you spend outdoors when it is cold, wet, and windy.
  • Cover yourself with several layers of loose and warm clothing.
  • Cover your ears with a hat or headband.
  • Try wearing mittens instead of gloves.
  • Wear thermal inner wears.
  • Cover your feet with well-fitted socks.
  • Look out for the early signs of frostbite like numbness, red skin, and prickling sensation.
  • Keep yourself hydrated when you go out.
  • Keep moving your hands and feet as it increases the blood flow.

Stages:

Frostbite occurs in many stages, which are,

1. Frostnip (First-Degree Frostbite)

It is a milder form and does not cause any permanent damage. Here, the skin turns red and cold to touch. Further cold exposure may cause numbness, burning, itching, and prickling sensation.

Treatment

Simple first-aid measures like preventing further cold exposure and rewarming. Rewarming is done by immersing the affected part in warm water for 15 to 30 minutes. Heat sources like stove and heat pads are contraindicated as they might cause burns. When your skin warms up, you might feel some pain or tingling sensation. Over-the-counter pain medications like Ibuprofen can be taken for the pain.

2. Superficial (Second-Degree) Frostbite

In this stage of frostbite, the skin turns pale or blue from red. The affected area is hard and frozen to touch. After this, due to inflammation, the skin may feel warm and swollen, which is the first sign of tissue damage. Immediate medical treatment is needed to prevent any further damage. Mostly, people recover from superficial frostbite without any permanent damage. But, some people face permanent problems like pain and numbness.

Treatment

The affected areas should be warmed as soon as possible. The doctor might administer pain medication and intravenous (IV) fluids. After the area is warm, the doctor will wrap the area to protect it. Sometimes, blisters develop after rewarming, in such cases, the doctor might drain it. And if the blister looks infected, antibiotics are prescribed.

3. Deep (Third-Degree) Frostbite:

It is the most severe form of frostbite, as it affects both the skin and underlying tissues. The affected skin turns white or bluish-gray and looks splotchy. You might experience numbness, loss of sensation, and pain. The muscles close to the affected part might not function properly. In severe cases, blood-filled blisters can be seen.

Treatment

Like all other stages, rewarming of the area is done. The doctor will give you pain medicine, IV fluids, and wrap the area. If you have developed blood-filled blisters, the doctor might give you a medicine called a “clot-buster.” This improves the blood flow to the affected area. After rewarming, the area is black and hard, due to tissue death. After 24 to 48 hours, large blisters might also develop. Depending on the damage, the affected area might need surgery to remove the dead tissues (debridement) or the area might be amputated.

Frostbite

What to Do If Your Child Develops Frostbite?

  • Bring your child indoors immediately. Do not try to warm the affected area in a cold place, as re-exposure to cold after warming up can cause permanent damage.
  • Remove all the wet and cold clothes.
  • Handle the affected area gently and do not rub it.
  • If blisters have formed, do not break them.
  • Warm by immersing the frostbitten parts in warm water (not hot) for 15 to 30 minutes.
  • If the fingers or toes are affected, place clean cotton in between each digit.
  • Wrap the warm area loosely with a clean bandage to prevent refreezing.

After these home remedies, if you do not see any improvement or if your child is in a lot of pain or if the affected area changes color and becomes hard, take your child to the emergency room.It often takes months for the damaged tissue to heal. So, doctors wait for months to see the changes after frostbite, to avoid surgical removal of tissues that may heal eventually or to leave tissues behind that might subsequently die. After the initial waiting period, 65 % of people suffer from permanent symptoms like pain, excessive sweating, and increased sensitivity to cold or heat. Always remember the signs of frostnip, as it is the first stage of frostbite. If you see yourself or somebody else developing those signs, cover yourself up, find a warm place, and seek medical attention immediately!

Last reviewed at: 27.Feb.2019

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