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- Exposure to extremely cold weather may cause freezing of body tissues, resulting in an injury. This condition is known as frostbite.
- If not immediately dealt with, frostbite can cause severe damage. Frostbite occurs in three stages. The symptoms increase in severity with each stage.
- Areas of the skin affected by frostbite appear greyish yellow or white and have a waxy or firm texture. Frostbite also numbs the skin.
- In mild cases, frostbite can be cured with home treatments. Medical help should be taken if the frostbite is severe.
- Problems such as diabetes, peripheral arterial disease, Raynaud phenomenon, and peripheral neuropathy that reduce blood circulation can increase the chances of frostbite.
What Is Frostbite?
Like water changes into ice at low temperatures, the skin can also freeze on being exposed to frigid weather conditions. This freezing of the skin along with the tissues present beneath it results in frostbite.
Body parts that generally remain exposed to the cold weather are prone to being frostbitten. These include the nose, toes, cheeks, chin, and ears.
In severe cases, the nerves, blood vessels, and muscles may also freeze along with the skin. Freezing of skin cells occurs due to the formation of ice crystals.
When you encounter extreme cold, the body decreases the blood supply to the extremities, such as the toes and fingers, to conserve body heat. This enables the formation of ice crystals in the extremities on long-term exposure to the cold.
These crystals hamper the circulation of blood by blocking the capillaries, thus depriving the cells of nutrients and oxygen supplied by the blood. The severity of the damage keeps on increasing as long as the tissue remains frozen.
Frostbite usually occurs on exposure to extremely chilly weather. However, mild temperatures intensified by conditions such as rain, wind, dampness, dehydration, low energy, or weak body can also cause frostbite.
What Causes Frostbite?
The body reacts to long-term exposure to cold weather by constricting the blood vessels of the extremities as they remain uncovered.
The narrowing of the blood vessels is the body’s way to conserve energy. It restricts blood supply to the extremities and redirects it to the vital organs instead, thus providing them adequate amounts of oxygen and nutrients. This also helps in keeping your body core warm.
If the blood supply to the extremities is not decreased, a greater amount of blood is exposed to the low temperature. This further reduces body temperature.
A lack of blood supply causes the extremities to become cold and commences the hunting response in which the dilation and constriction of blood vessels take place alternately.
The dilation is timed so that the temperature of the extremities can be maintained with a minimum amount of blood flow to those areas. This body mechanism helps retain the functionality of the extremities.
However, when there is a risk of hypothermia (body temperature around 96 °F), the constriction sustains for long to prevent the exposure of vital organs to cold blood. Due to the restricted blood flow to the extremities, frostbite occurs.
The risk of frostbite increases at temperatures below 5 °F (-15 °C) and chilly wind at a temperature of -16.6 °F (-27 °C) can speed up the process. Infants and older adults, are more susceptible to frostbite than young individuals.
The following factors may increase the chances of developing frostbite:
- Lack of proper warm clothes
- Lack of shelter
- Conditions of hypoxia
- Alcohol consumption
- Use of beta-blockers (medications taken by individuals who have cardiac problems) that lower the blood pressure
- Medical problems such as diabetes and hypothyroidism
- Diminished blood flow to the legs due to peripheral artery disease (PAD), wherein the blood vessels in the legs become hard and narrow
- Blood vessel spasms caused by the Raynaud phenomenon. These affect blood flow to the toes, nose, ears, and fingers and may occur due to emotional uproars or the cold weather
Different Stages of Frostbite
Frostbite occurs in three stages:
- Superficial Frostbite: Mild frostbite, also known as frostnip, is characterized by a change in the appearance of the skin. The affected areas may appear greyish or white and have a waxy touch. It is generally a non-freezing injury.
Warm water can be applied to the affected area, after which the skin may turn red and start peeling like in sunburn.
- Partial-Thickness Frostbite: The affected parts of the body lose sensation. They become hard and may fail to regain original form after being pressed.
- Full-Thickness Frostbite: The most severe degree of frostbite causes permanent tissue damage. If not treated on time, the affected tissue may become nonfunctional due to cell death and may turn black.
How to Know It Is a Frostbite?
The symptoms of frostbite vary with each stage but commonly include the following:
- Freezing of only the outer layer of the skin while the tissue beneath it remains soft (superficial frostbite)
- Frozen and solid tissue layers (deep frostbite)
- Waxy texture of the skin
- White or grayish patches on the skin
- Formation of blisters filled with pus or blood
- Gangrene (dead, black tissue) in extreme cases
Frostbite can be diagnosed by checking for the presence of visual symptoms such as skin discoloration and numbness. However, the severity of frostbite is difficult to estimate at once and requires a few weeks of treatment.
Laboratory tests such as MRI and X-rays can be performed to identify any complications occurring due to frostbite, which may be causing restricted blood flow or tissue ischemia.
You may not feel your tissues getting frozen as the cold can cause numbness. Thus, it is essential to recognize the early signs of frostbite, such as the tingling sensation associated with frostnip.
Recognizing frostnip early enables you to take proactive measures for avoiding the complications of frostbite.
Clinical Treatment for Frostbite
A mild case of frostbite or frostnip does not require medical attention and can be treated using at-home first aid. However, other cases of frostbite should be assessed and treated clinically.
It is necessary to provide first aid and check for hypothermia. On diagnosis, appropriate treatment is assigned, which can include medicines, rewarming therapy, surgery, and wound care.
The clinical treatment for frostbite depends on its severity:
- Oral antibiotics are prescribed if you develop an infection where blisters have formed.
- Removal of dead tissue by amputation or surgery is necessary to prevent the spread of infection.
- While rewarming, pain medications can be prescribed to help subside the pain.
- Anti-inflammatory drugs are given to prevent swelling in the affected area.
- Intravenous injection (IV) may be administered to remove clots and help restore blood circulation.
- Hyperbaric oxygen therapy (HBO2) increases the oxygen-carrying capacity of the blood. This ensures that sufficient oxygen reaches areas of frostbite injury to alleviate ischemia. It also helps in preventing oxidative damage by increasing the supply of antioxidants to the affected areas.
It is important to avoid rubbing the affected area and prevent exposure to snow. Do not dip numb hands or feet in hot water as you might be unable to sense if the water is too hot.
Using a blood thinner or aspirin may help by increasing blood circulation. These medications can be taken after rewarming therapy within 24 hours. However, it is highly advised to seek guidance from your doctor for this.
Treatment and Prevention
Frostbite occurs due to prolonged exposure to frigid temperatures. To prevent and treat frostbite, you should stay warm. The following tips may be useful:
- Elevate the affected parts. To reduce swelling and numbness, keep the frostbitten parts in an elevated position.
- Take shelter in warm places. To prevent frostbite from worsening and causing severe damage, it is important to get yourself to warm places immediately.
- Take some rest. Avoid excessive movement of the affected areas to enhance the recovery process. Elevate the affected part to boost blood circulation.
- Wear warm clothes. It is recommended to layer up in light and loose clothes, so that warm air is trapped close to your body. Wear synthetic clothes to absorb moisture.
On top of them, wear an insulating material such as wool or fleece to trap the body heat. On the outside, wear materials that are waterproof and windproof. Avoid tight clothing, as it increases the chances of frostbite.
- Cover your head. Use hats and ski masks to cover your nose and ears. Prevent exposure to cold air by wearing windproof or woolen materials.
- Protect your extremities. Wear socks that can absorb moisture. Layer them with a woolen pair of socks. The boots that you use should be ankle high and waterproof. Wear woolen gloves at all times.
- Prevent entry of snow into your clothing. Wear insulating materials when going in the snow. Use ankle-high boots to prevent the entry of snow. Change your clothes immediately if they get wet. Wet clothing makes you more vulnerable to frostbite.
- Stay hydrated. Dehydration can increase your chances of developing a frostbite. You may not sense thirst in cold weather, but it is essential to drink ample amounts of water.
Remember to consume water before heading for any outdoor activity. To prevent dehydration, avoid consumption of alcohol as it is a diuretic.
- Use warm water. Soaking the affected areas in warm water helps improve blood circulation. It also helps by dilating the nerves and relaxing the muscles.
A study conducted in 2010 showed the efficacy of soaking the hands and feet in warm water (104 °F to 107 °F) for 30 minutes as an immediate treatment for frostbite. (1)
- Consume ginger tea. Along with your prescribed medication, drink ginger tea to boost recovery. Gingerols and zingerone, the active compounds in ginger, help in improving blood flow and raising internal body temperature. These, in turn, help alleviate the symptoms of frostbite.
- Use aloe vera. The application of aloe vera gel to the skin has been shown to treat frostbite. Aloe vera helps improve blood flow and prevent cell death. (2)
- Consume warm turmeric milk. Curcumin, an anti-inflammatory agent found in turmeric, helps in increasing blood circulation. Turmeric also helps to alleviate pain and reduces the feeling of discomfort.
- Rewarm. Frostbite-affected areas can be treated with rewarming therapy. For this purpose, bathwater is maintained at 38 °C, and antiseptic solutions such as chlorhexidine or povidone-iodine are added. Rewarming may be done for 15-30 minutes, depending on the severity of the frostbite.
It may be continued for an hour or until the affected area turns red and becomes soft. Temperatures between 37 °C and 39 °C have been shown to alleviate pain and are recommended by the Wilderness Medical Society and the Cold Injury Guidelines of the State of Alaska. (3)
Do not use rewarming therapy if you may be re-exposed to severe cold. Refreezing may cause permanent damage. After the rewarming therapy, wrap the affected areas in clean bandages. The toes and fingers should be separated. Maintain cleanliness to prevent infection.
The first step toward treating frostbite is to get back the sensation in the affected area. This should be done progressively. However, if the numbness does not go away or the skin becomes greyish, seek immediate medical attention.
Complications of Frostbite
A severe case of frostbite may cause complications that may persist for a long time. These problems include:
- Increased sensitivity to low temperatures
- Loss of sensation in the affected parts, such as the fingers
- Pain in the affected parts
- Growth-related issues in children (if the growth plate of a bone is frostbitten)
Some General Queries Regarding Frostbite
Can cayenne pepper help in treating frostbite?
Cayenne pepper contains capsaicin that helps in treating frostbite by enhancing blood circulation in the body. It can be administered topically or orally. However, there has been no scientific study establishing the role of cayenne pepper in treating frostbite.
Is it possible to walk on frostbitten feet?
While it is possible to do so, walking on frostbitten feet causes further damage and thus should be avoided.
Can a heating pad, a heat lamp, or stove heat be used on a frostbitten area?
The heat from a stove, radiator, heating pad, or heat lamp can burn your skin and should be avoided. This is because the frostbitten area is numb, and you may not feel your skin burning until it’s too late.
Can frostbite lead to amputation?
Extreme frostbite can cause gangrene formation (death of tissue). Extremities affected with gangrene need to be amputated to prevent the spread of disease to the whole body.
What is the difference between chilblains, frostnip, and frostbite?
The formation of colored patches on the skin as a reaction to cold temperatures is known as chilblain. The affected areas develop a rash and swell up. However, it improves in a few weeks if warm conditions are provided.
Frostnip is the freezing of the outer layers of the skin. This occurs in cold weather due to improper blood supply through constricted blood vessels. The skin turns whitish and becomes numb. It is the first stage of frostbite and is easily reversible.
If frostnip is not treated, it may develop into frostbite on persistent exposure to cold weather conditions. The tissue freezes and incurs permanent damage.
Until when do the effects of frostbite last?
If the frostbite is in its initial stages, where only the outer layers have frozen, complete recovery is possible. The frostbitten areas require time to gain functionality and may or may not be able to regain complete sensation.
On exposure to cold weather, the frostbitten areas get cold faster in comparison with the other areas.
Is frostbite fatal?
Frostbite increases the chances of contracting bacterial infections such as tetanus through the wounds.
The infection may spread into the blood and cause blood poisoning or septicemia, which can result in tissue damage and organ failure. This can also lead to death.
When to See a Doctor
It is recommended to seek medical help in all cases of frostbite. You should seek immediate medical attention in the following conditions:
- Black or white discoloration of the skin
- Numbness in the affected area
- Symptoms of hypothermia
- Hard skin
- Persistent shivering or pain after rewarming
- Frostbite associated with injury
- Mumbled speech
- Inability to stand straight
- No effect of rewarming on the numbness or discoloration of the skin
- Development of blisters in the affected area
- Low body temperature (below 94 °F)
What you may ask your doctor:
- What measures should I take while the frostbite subsides?
- What signs on my skin should I notice?
- Do I need to undergo any tests?
- How can I treat the frostbite?
- Will the affected area be cured completely?
What your doctor may ask you:
- Have you had frostbite before?
- When did the symptoms first occur?
- Have you undergone any treatment?
- What medications have you taken for the treatment, if any?
Frostbite causes damage to the tissues due to freezing. Deep frostbites can be life-threatening. There is an increase in the incidence of frostbite among the younger population who are taking risks in the name of recreational activities.
It is vital to seek medical care immediately. Timely treatment helps in preventing permanent tissue damage and regaining complete sensation in affected areas.
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