Frostbite

Symptoms of frostbite include:

• Numbness.
• Tingling.
• Patches of skin in shades of red, white, blue, gray, purple or brown. The color of affected skin depends on how serious the frostbite is and the usual skin color.
• Cold, hard, waxy-looking skin.
• Clumsiness due to joint stiffness.
• Pain.
• Blistering after rewarming.

Frostbite is most common on the fingers, toes, ears, cheeks, penis, chin and tip of the nose. Because of numbness, you may not notice you have frostbite until someone points it out. Changes in the color of the affected area might be difficult to see on brown and Black skin.

Frostbite occurs in several stages:

• Frostnip. Frostnip is the early stage of frostbite. Symptoms are pain, tingling and numbness. Frostnip doesn’t cause permanent damage to the skin.
• Mild to moderate frostbite. Frostbite causes slight changes in skin color. The skin may begin to feel warm. This is a sign of serious skin involvement. If you treat frostbite with rewarming at this stage, the surface of the skin may look patchy. The affected area may sting, burn and swell. A fluid-filled blister may form 12 to 36 hours after rewarming. This stage also is called superficial frostbite.
• Deep frostbite. As frostbite progresses, it affects all layers of the skin and the tissues below. The affected skin turns white or blue-gray. Large blood blisters may appear 24 to 48 hours after rewarming. Weeks after the injury, tissue may turn black and hard as it dies.

Other than frostnip, frostbite injuries need to be checked by a healthcare professional to find out how serious they are.

Seek emergency care for:

• Intense pain even after taking a pain reliever and rewarming.
• Intense shivering.
• Slurred speech.
• Drowsiness.
• Trouble walking.

People with frostbite also might have hypothermia. Shivering, slurred speech, and being sleepy or clumsy are symptoms of hypothermia. In babies, symptoms are cold skin, a change in skin color and very low energy. Hypothermia is a serious condition in which the body loses heat faster than it can be produced.

The most common cause of frostbite is exposure to freezing cold. The risk rises if the weather also is wet and windy. Frostbite also can be caused by direct contact with ice, freezing metals or very cold liquids.

Risk factors for frostbite include:

• Being in freezing conditions without protective clothing.
• Having certain medical conditions, such as diabetes, exhaustion, poor blood flow or congestive heart failure.
• Regularly smoking tobacco.
• Having impaired judgment while in very cold conditions.
• Having had frostbite or another cold injury in the past.
• Being an infant or older adult in cold conditions. People in these age groups have a harder time producing and retaining body heat.
• Being in cold conditions at high altitude.

Complications of frostbite include:

• Hypothermia.
• Increased sensitivity to cold and a higher risk of frostbite in the future.
• Long-term numbness in the affected area.
• Excessive sweating, also called hyperhidrosis.
• Changes in or loss of nails.
• Growth problems in children if frostbite damages a bone’s growth plate.
• Infection.
• Tetanus.
• Gangrene, which can result in having the affected area removed. This procedure is called amputation.

Diagnosing frostbite is based on your symptoms and a review of recent activities during which you were exposed to cold.

Your healthcare team may have you undergo X-rays or an MRI to look for bone or muscle damage. It may take 2 to 4 days after rewarming to tell the extent of tissue damage.

• If you suspect hypothermia, call for emergency help.
• Protect the injured area from further damage. Do not try to rewarm the frostbitten skin if it might freeze again.
• Get out of the cold, remove wet clothes and wrap up in a warm blanket.

• If possible, soak the skin with frostbite in a tub or sink of warm water for about 30 minutes. For frostbite on the nose or ears, cover the area with warm, wet cloths for about 30 minutes.

  Another option is to warm the affected skin with body heat. For example, tuck frostbitten fingers under an armpit.

• Don’t walk on frostbitten feet or toes if possible.
• Take a nonprescription pain reliever if needed.
• Drink a warm, nonalcoholic beverage.
• Remove rings or other tight items. Do this before the injured area swells with rewarming.
• Don’t apply direct heat. For example, don’t warm the skin with a heating pad, a heat lamp, a blow-dryer or a car heater.
• Don’t rub the frostbitten skin.

After providing first aid, seek treatment from a healthcare professional if you have frostbite. Treatment may involve rewarming, medicine, wound care, surgery or other steps depending on how serious the injury is.

• Rewarm the skin. If the skin hasn’t been rewarmed already, your healthcare team rewarms the area using a warm-water bath for 15 to 30 minutes. The skin may turn soft. You may be asked to gently move the affected area as it rewarms.
• Take pain medicine. Because the rewarming process can be painful, you may be given a pain reliever.
• Protect the injury. Once the skin thaws, your healthcare team may loosely wrap the area with sterile sheets, towels or dressings to protect the skin. You may need to raise the affected area to reduce swelling.
• Soak in a whirlpool. Soaking in a whirlpool bath can aid healing, as it keeps the skin clean and naturally removes dead tissue.
• Take infection-fighting drugs. If the skin or blisters look infected, your healthcare team may prescribe antibiotic medicine taken by mouth.

• Take medicine. You may receive an injection of medicine in a vein that helps restore blood flow. This type of medicine is called a thrombolytic. One example is tissue plasminogen activator, also called TPA. Studies of people with severe frostbite show that TPA may lower the risk of amputation. But this medicine can cause serious bleeding. It’s sometimes used in serious situations and within 24 hours of cold exposure.

  Another medicine that improves blood flow is iloprost (Aurlumyn). It was recently approved by the FDA for severe frostbite in adults. It can reduce the risk of finger or toe amputation. Side effects of this medicine include headache, flushing and heart palpitations.

• Remove damaged tissue. To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. This procedure to remove this tissue is called debridement.
• Tend to blisters and wounds. Blisters can act as a natural dressing. Depending on the type of blisters, your healthcare team may leave them to heal on their own or drain them. A variety of wound care techniques may be used depending on the extent of injury.
• Undergo surgery. People who have experienced severe frostbite may in time need surgery or amputation to remove dead or decaying tissue.