Frostbite

Overview

Frostbite occurs when the skin and underlying tissues freeze, resulting in injury. In its early stage, known as frostnip, it causes a cold sensation followed by numbness. As frostbite progresses, the affected skin may change color and appear hardened or waxy.

Exposed skin in cold and windy conditions is particularly vulnerable to frostbite. Frostbite can also develop on skin that is covered by gloves or other clothing. Sometimes, frostbite may not be recognized until someone else points it out.

Mild frostbite can often be treated with rewarming, but more severe cases of frostbite require medical attention due to the potential for permanent damage to the skin, muscles, bones, and other tissues.

Symptoms

Signs and symptoms of frostbite encompass:

• Numbness
• A tingling sensation
• Cold skin
• Skin appearing hard or waxy in texture
• Pain
• Clumsiness attributed to stiffness in joints
• Possible blistering upon rewarming, particularly in severe cases
• Skin displaying hues such as red, white, bluish-white, grayish-yellow, purplish, brown, or ashen, contingent on the seriousness of the condition and the individual’s typical skin color

Frostbite predominantly affects areas such as the fingers, toes, nose, ears, cheeks, chin, and penis. Due to numbness in the skin, individuals may not be aware of frostbite until someone else brings it to their attention. Discerning changes in the color of the affected region can be challenging, especially on brown or Black skin.

The progression of frostbite unfolds in multiple stages:

• Frostnip. Frostnip is the initial stage of frostbite characterized by symptoms such as pain, tingling, and numbness. Frostnip does not result in lasting damage to the skin
• Superficial frostbite. Superficial frostbite induces minor alterations in skin color. The skin may start to feel warm, indicating serious skin involvement. If you attempt rewarming treatment for frostbite at this stage, the skin surface may appear patchy. Sensations of stinging, burning, and swelling may become apparent, and a fluid-filled blister might emerge 12 to 36 hours after the skin has been warmed.
• Deep (severe) frostbite. Advancing through its stages, frostbite impacts not only the outer layers of the skin but also the underlying tissues. The affected skin can change color to white or blue-gray. Large blood blisters may develop within 24 to 48 hours after rewarming. Over the following weeks, the tissue may darken and harden as it dies. Sizable blood blisters may develop within 24 to 48 hours after the rewarming process. Over the following weeks, the tissue may darken and harden as it dies.

If you suspect frostbite, it’s crucial to have it evaluated by a healthcare professional to assess the severity. Seek emergency care if you experience:

• Persistent, severe pain despite pain relievers and rewarming
• Intense shivering
• Slurred speech
• Extreme drowsiness
• Difficulty walking

Frostbite can also be accompanied by hypothermia. Symptoms of hypothermia include shivering, slurred speech, and unusual sleepiness or clumsiness. In babies, symptoms of hypothermia include cold skin, color changes, and very low energy. Hypothermia is a critical condition where the body loses heat faster than it can generate it.

Causes

Frostbite occurs when skin and underlying tissues freeze, often due to exposure to cold weather. However, it can also result from direct contact with ice, freezing metals, or extremely cold liquids. Factors contributing to frostbite include:

1. Inappropriate clothing for the conditions, such as inadequate protection against cold, wind, or wet weather, or clothing that is too tight.
2. Prolonged exposure to cold and windy conditions.When the wind chill is -15°F (-26°C) or lower, frostbite can develop in 30 minutes or less.

Risk factors

The risk of frostbite is heightened by the following factors:

• Infancy or advanced age, as both age groups may face challenges in generating and retaining body heat
• Alcohol or drug use
• Smoking
• Exposure to freezing temperatures without protective clothing.
• Being in cold conditions at a high altitude.
• Impaired judgment in extremely cold conditions.
• Prior history of frostbite or cold-related injuries
• Possess an existing medical condition such as peripheral vascular disease, malnutrition, Raynaud’s syndrome, hypothyroidism, arthritis, or diabetes.