Frostbite is a condition most of us associate with mountain climbers and regions with extreme temperatures such as the Himalayas. However, temperatures in the US can drop low enough for frostbite to become a problem, so understanding the condition is important. Frostbite is the common name for the freezing of the skin and tissue underneath.

It is most common in people who explore the great outdoors in extreme temperatures but can affect anybody exposed to freezing temperatures. The US National Library of Medicine states that frostbite is the most common freezing injury, so it is much more prevalent than many of us probably thought.

Table of Contents:

  1. Cause of Frostbite
  2. Preventing Frostbite from Developing
  3. Diagnosing Frostbite
  4. How is Frostbite Treated?
  5. Long Term Symptoms of Frostbite

The Cause and Onset of Frostbite

Frostbite occurs when the skin is exposed to freezing temperatures. Normally, it can happy in just a few minutes although it be up to an hour or two in some circumstances. The onset of frostbite depends on a lot of factors including the ambient temperature, wind chill and length of exposure to the cold. The colder the temperature and additional wind chill will speed up the process. The onset of frostbite also depends upon the individual. The age or size of the person will impact on the speed at which the condition takes hold. Children will experience frostbite much more quickly than larger, older adults.
You are also more at risk of getting frostbite if you have any of the following conditions:

  • Diabetes
  • A range of autoimmune vascular disorders such as Lupus or Vasculitis
  • Atherosclerosis obliterans

All of these conditions can cause less than optimal circulation and therefore, frostbite can become more serious more quickly too. As frostbite affects the body’s extremities, any pre-existing circulatory problems can exacerbate the condition.

Some areas of the body are also more susceptible to frostbite than others. Any skin surface is at risk of frostbite but those furthest from the center of the body where the heart pumps from, are at higher risk. This means areas such as hands, fingers, feet, ear lobes, face and the tip of the nose.

Finally, certain groups of people are also at higher risk of frostbite due to their lifestyle or working environment. You are at higher risk of frostbite if:

  • You spend a lot of time outside for work or due to your circumstances
  • You are under the influence of alcohol
  • You are elderly with inadequate access to heating or food and water
  • You have a mental illness

Frostbite and related conditions such as hypothermia are sadly a common cause of death for homeless people and elderly people who are not able to find warmth, heating and the food and water required to deal with the condition.

How does the Cold Affect your Body and Skin?

At the very minimum, we make basic changes to our skincare routine in the winter months. Cold weather impacts our skin and body in many ways which we need to respond. Cold temperatures pull heat away from your body. This is also true of wind, rain and even when we sweat. Sitting or standing on cold ground also causes you to lose breath.

Cold weather forces the human body to work harder to keep its core temperature as warm as possible. This is to ensure your vital organs are protected and are not at risk of freezing. To keep warm, the body slows blood circulations to its extremities, including the face, arms, hands, legs and feet. This is why they become colder more quickly and are the first body parts at risk from frostbite.

If your core temperature drops even a few degrees, hypothermia takes over. Even mild hypothermia causes your body and brain to function incorrectly and severe hypothermia is often fatal. Even the earliest stages of hypothermia can leave you confused and unable to function properly, with stumbling, forgetfulness and inability to formulate proper sentences all clear signs that hypothermia is setting in.

Stages of Frostbite

Frostbite is officially divided into three different stages by most medical professionals. Below is a look at each of the stages. It is important to be acutely aware of the early stages of cold weather injuries and symptoms, to avoid them developing into frostbite and hypothermia.

Stage One: Frostnip

The earliest stage of frostbite is known as frostnip. Common signs and symptoms include:

  • Reddened cold skin which may start to turn white but remain soft
  • Numbness of the skin
  • Tingling
  • Sore, cold stinging
  • Prickly skin

This can also be teamed with early signs of hypothermia which include shivering and stumbling and mumbling, which can be an indication that the cold is affecting the brain, as well as the body. Frostnip can almost always be reversed very quickly by simply warming yourself up and getting indoors as quickly as possible before it becomes a serious problem.

Stage Two: Superficial Frostbite

Superficial frostbite is significantly more serious than frostnip. The skin begins to turn fully white and pale. The skin may still feel soft but often you will see ice crystals forming upon the tissue, beneath the surface. It is also common that the body part might actually still feel warm to the person with frostbite, despite it being very cold. Body parts with superficial frostbite need to be rewarmed by medical professionals. When the process takes place, the skin may turn mottled blue and purple. It may also swell. It is also common for fluid filled blisters to develop in the 24-36 hours after treatment for superficial frostbite.

Stage Three: Severe Frostbite

Severe or deep frostbite is the final stage of the condition. It affects all layers of the skin and also the tissues beneath it. At this stage the area may be numb, with discomfort or sensation of cold at all. The joints and muscles in the area may also seize up and stop working. Once the area is rewarmed, large blisters almost always develop within the following 24 to 48 hours. The area will also turn black as the tissue has died and, in many instances, amputation will be necessary to protect the rest of the body.

Preventing Frostbite from Developing

Sometimes going out in freezing conditions is unavoidable or the temperature drops suddenly while you are already out. To prevent frostbite and related hypothermia from developing, you need to act quickly. Take immediate action such as:

  • Get out of the cold if at all possible
  • Drink fluids and eat carbohydrates
  • Add warm layers of clothing if available
  • Move your body as much as possible to warm up your core
  • Focus on warming up any area experiencing frostnip. Be sure to remove any jewelry, place cold fingers in your armpits and warm the tip of your nose and ears with the palm of your hand. You should never rub an area suffering with frostnip.

It is also possible to prepare against frostbite before you leave. If you know there is a risk of freezing temperatures, then you can follow the guidelines below:

Layer up your Clothing

Wearing layers of clothing is key to staying safe in the cold. The right shoes can also help. Layered clothing protects your body from the cold in a number of ways including:

  1. Protecting you from direct contact with cold surfaces
  2. Protecting you from cold blasts of air, wind, snow and rain
  3. Keeping the heat of your body trapped inside

There are particular methods for layering clothing that can be the most effective. As a minimum you may need:

Your Inner Layer

This wicks the sweat away from the skin. Sweat can cool the skin down which is the last thing you need in freezing temperatures. Inner layers are often lightweight and made from polyester, polypropylene or wool. Cotton is not recommended for cold weather as it absorbs moisture and keeps it against your skin, adding to the cold.

Your Middle Layer

The middle layer of clothing is key to keeping the heat in and insulating against the cold. Common materials for middle layers include polyester fleece, down, microfiber or wool. Depending on the temperatures you may wear multiple middle layers.

Your Outer Layer

Your outer layer of clothing should repel the elements. This means it should be waterproof but also wind resistant and protect against the cold. Outer layers need to be made from breathable fabrics to avoid sweat building up. In addition to your main clothing layers, your hands, feet, neck and face need additional protection from the cold. The right hat, scarf, gloves, socks and footwear are key. Additional accessories such as face masks have been designed to ensure the whole face is protected against the cold. While they can seem like an extreme choice, the face and the tip of the nose are often the first affected by frostbite so need the most protection.

Eat and Drink Regularly

You need to keep your body fueled and hydrated in the cold. Frostbite and hypothermia are much more likely to set in if you do not eat or drink enough. Foods high in carbohydrates give you quick energy and can help keep your energy levels high as you spend time outside. Food with high levels of protein and fat are good fuel if you plan to spend many hours outside in the cold. It is common not to feel thirsty in cold weather but keeping your fluid levels high is essential. Dehydration is another common condition which occurs alongside frostbite.

When Do You Need Medical Attention for Frostbite?

If you believe that any type of frostbite has set into your body, you need medical attention. A healthcare professional can take a look at the affected area and examine it to give a diagnosis. It is important the area is seen in person by a medical professional for the right treatment. It is hard for even the most experienced medical professionals to judge the severity of frostbite on initial examination. They can supervise the rewarming process which is essential for recovering from frostbite. They can also provide treatment for hypothermia and dehydration where necessary.

Diagnosing Frostbite

Frostbite diagnosis is usually fairly quick although treatment may vary dependent on the severity of the condition. The doctor will examine the patient fully, take into account their medical history and the recent circumstances which have led to the freezing of the skin and tissue. They will also:

  • Note all vital signs to treat any life threatening symptoms such as severe hypothermia or infection
  • X-rays and other scans may be carried out to judge the depth and severity of the frostbite
  • Utilize all the data to classify the frostbite as superficial or severe and be able to give a qualified prognosis

A good prognosis for frostbite is usually given when the patient has sensation in the area, normal skin color, pressure causing movement or change to the skin, clear fluid blisters and the skin returning to a pinker tone when thawed. A poor prognosis features blisters with dark fluid, dark blue skin when thawed and no amount of pressure including indents or changes to the skin. A poor prognosis is much more likely to result in amputation to ensure the rest of the body can be protected against the frostbite.

Immediate Actions for the Treatment of Frostbite

Prior to attending a doctor’s appointment or the emergency team arriving, there are some things you can do to minimize the impact of frostbite. These include:

  • Elevating the affected body part to bring down any swelling
  • Moving to the warmest available area to minimize any further heat loss
  • Avoiding walking if at all possible when the toes or feet are affected
  • Looking out for symptoms of hypothermia and responding to these first as they can be life threatening
  • Drinking fluids as regularly as possible
  • Warming the area if there is no risk of refreezing.
  • Avoiding rubbing the affected area. This friction against the frozen skin and tissue can further damage the tissue and may mean it cannot be saved.
  • Applying sterile bandages where possible and position cotton between affected digits to avoid rubbing
  • Getting to a medical facility as quickly as possible or ensuring the emergency team are able to get to you with ease

Rapid treatment is absolutely essential in ensuring frostbite does not become a life threatening problem. Without rapid treatment more of the body’s tissue may become affected and die.

How is Frostbite Treated in the Hospital?

Most people with frostbite have more pressing emergency medical conditions to deal with first. Once hypothermia, dehydration and other life-threatening problems are under control, frostbite treatment can begin. Rewarming is key process in treating the initial symptoms of frostbite, as the body needs to return to a safe temperature. The rewarming process can be painful and follows these steps:

  1. The affected area or whole body will be rapidly heated in a circulating water bath which will reach temperatures up to 107.6F. This will continue until the thaw is fully complete which is usually carried out within 30 minutes.
  2. Patients will be provided with narcotic pain medications due to the discomfort involved in the process.
  3. Patients may also have IV fluids as dehydration is a common side effect of the rewarming process.

Once rewarming is complete, close care and attention is necessary to prevent infection in the affected area and due to continuing lack of oxygen in the area. Healthcare professionals will also:

  1. Debride all clear blisters, which means removing the dead tissue from the area. Bloody or darker blisters are left in tact to ensure underlying blood vessels are not damaged.
  2. When there is risk of singular or multiple amputation a tissue plasminogen activator may be given directly into the artery. This reduces the incidence of blood clots.
  3. Provide tetanus injection where necessary

Most people with frostbite are hospitalized for at least two days so they can get the right treatment and the severity of the injury can be assessed. As well as water and rewarming therapy, patients may also be given anti-inflammatory drugs and soothing Aloe Vera creams and gels may applied to help reduce pain in the area. The affected area is also usually elevated and held in a splint to help reduce any swelling and promote circulation to the area, where possible.

There are specialists in frostbite trialing a number of experimental therapies. They include the continued use of Aloe Vera and also the use of intra-arterial sympathetic blocking drugs. While no research has proven conclusive in guaranteeing improved results, there have been positive results and it is becoming less common that amputations are necessary.

When Does Frostbite lead to Amputation?

The idea of having a digit or limb amputated is extremely difficult to think about. However, frostbite can result in amputation in the most severe cases. It is usually the case that amputation becomes necessary when gangrene or infection sets in.

Amputation is never an immediate solution for frostbite and usually, will not take place for many months after the initial treatment. It can take several months for the final separation between a body’s healthy and dead tissue to be complete. It is possible for the body’s tissue to recover from frostbite and performing amputation too early can result in losing digits and limbs which may have been able fully recover, or at least recover in part.

Advanced radiographic technologies are being trialed to try and speed up this process, so doctors can act more quickly and given patients less of a wait between initial treatment and knowing their final prognosis. The time between initially getting frostbite and final prognosis can be extremely difficult for patients to deal with, as doctors simply cannot know in advance whether amputation is or isn’t necessary. The risk of amputating flesh which has the potential to return to normal is usually not worth the risk.

Are there long-term or lasting symptoms of Frostbite?

For patients where no amputation is needed, there are still some longer-term symptoms of frostbite. Common symptoms include severe flashes of pain in the formerly affected area or abnormal sensations in the area. Patients often have lifelong heat or cold sensitivity in the area and can also develop conditions such as arthritis due to the trauma.

Complex Regional Pain Syndrome

Many people who recover from frostbite are left with complex regional pain syndrome. This difficult-to-treat condition can be caused by many different kinds of injury and trauma, but it is common among people who have suffered from superficial or severe frostbite in the past.

Avoiding Frostbite in Colder Climates

Frostbite is almost always avoidable. A lot of cases are due to incorrect information or poor knowledge on the subject. People who live in areas with regularly freezing temperatures tend to have a good understanding of the necessary requirements to stay warm and safe in the coldest temperatures. However, when a sharp downturn in temperature occurs or unexpected freezing temperatures occur, more cases of frostbite are reported. It is not always possible to be fully prepared for the onset of colder temperatures but if you are prepared with the right layers, food and drink, you can protect against frostbite most of the time.

Common Sense in Winter

It is important to note that frostbite can occur in mere minutes in the coldest of conditions so fast action is key. Any signs of redness to the skin are a sign that it’s time to go inside, especially when there is no indication that the temperatures will rise. The much more dangerous and potentially fatal condition hypothermia is often close behind frostbite, so reacting quickly avoids a much more severe and dangerous medical situation.

Enjoy Winter, Without the Risk

Many of us look forward to getting out in the snow and ice, especially with our families. There is no reason to avoid this as long as you use common sense and ensure you and all family members are fully wrapped up. The pain and discomfort associated with frostbite are not worth the risk, especially when it can usually be avoided with the right clothing and recognizing when it’s time to head inside.

Resources:
https://commons.wikimedia.org/wiki/Category:Frostbite#/media/File:Frostbite.jpg
https://commons.wikimedia.org/wiki/File:Frostbitten_hands.jpg
https://commons.wikimedia.org/wiki/File:%D0%A1ongelatio_01.JPG
https://unsplash.com/photos/KNUp-YBwBSE
https://unsplash.com/photos/5AiWn2U10cw
https://unsplash.com/photos/mjjS5a8VROw