Risk of Frostbite
Prevention and treatment of frostbite
By Ric Allen, M.D.,
When cold, wet weather comes, as it does each year, with it comes an
increased risk for frostbite.
Frostbite can be treacherous because it often occurs when we're enjoying
outdoor activities like hunting, downhill skiing, ice-skating, or hiking. When
we choose to ignore the signals that our bodies are getting too cold, we put
ourselves at risk for damage to exposed skin and extremities. Faces, fingers,
toes, ears, and noses are the most common areas for frostbite.
Types of cold weather injury
There are four basic types of cold weather injury. Pernio,
commonly known as chilblain, occurs when skin is repeatedly exposed in cold,
dry weather conditions. Joggers and people whose work puts them outside in cold
weather often develop patches of itchy, red skin on their faces and other areas
of unprotected skin. These red patches may blister, which can lead to scarring
as the skin heals. The best way to prevent pernio is
to cover your skin when outside.
Frostnip, which most of us experience at one time
or another, occurs when the skin and extremities begin to have a burning or
numb sensation and the skin appears white. These
symptoms indicate that the temperature of the skin is very low and is in danger
of freezing. Treat frostnip by going inside, removing
restrictive clothing (which cuts off circulation), and allowing your skin to
regain heat naturally. As you rewarm,
you will experience a tingling sensation and your skin may look redder that
usual for a while. Avoid consuming alcohol until all of your symptoms
Another common cold-weather injury, known as immersion foot, occurs when the
feet are wet and cold for a long period of time. You can get immersion foot
from walking around in wet shoes or boots in cold weather. Hunters and children
playing outside in the cold are at special risk for this condition. People with
immersion foot find that even after they have dried their feet, they remain
clammy and pale, and are very sensitive to the touch. Though the feet are not
frozen, immersion foot can cause quite a bit of tissue damage. The feet should
be gradually and carefully rewarmed; do not
vigorously rub them as this can increase tissue damage.
Frostbite, the most serious of the cold weather injuries, occurs when body
tissue actually freezes. There are three stages of frostbite which, like burns,
are based on the depth of the injury. The first symptoms of frostbite are
similar to those of frostnip; a pins-and-needles sensation
followed by numbness. When frostbite sets in, the skin first appears waxy,
white, and hard, and then becomes red and swollen. You can no longer move the
skin around like you can under normal circumstances, and there is no capillary
refill when you push hard on the skin with your finger.
If you think you have frostbite, don't rub the area and don't try to warm it
slowly. Simply cover the effected tissue and get to an emergency room as
quickly as possible. There, the medical staff will rewarm
the tissue by immersing it in warm water (104-108 degrees Fahrenheit). The rewarming process causes significant pain, and in the
hospital setting we are able to provide analgesia to offset the discomfort.
After the tissue has thawed, blisters will form which help to determine the
prognosis for healing. With a bad case of frostbite, it can take months to know
the extent of the permanent damage. Tissue that has suffered frostbite should
be handled gently and with extreme care.
At special risk
Babies and small children are at increased risk for frostbite because they
can't make their needs known. People who have impaired mental abilities are at
risk, as are those with Alzheimer's disease. Alcohol consumption is often an
aggravating factor in cases of frostbite. Smokers and people with high blood
pressure, heart or vascular disease, and diabetes should take special
Dress appropriately for the weather in layers of clothing that are not
restrictive, and wear a warm hat that protects your ears. Avoid alcohol because
it alters your mental status and judgment. Recognize that babies and children
are at greater risk than adults, and take special care to protect them.
Dr. Allen is board certified by
the American College of Emergency Physicians. He
practices emergency medicine in the Emergency Department at Cayuga Medical