What is Frostbite?
Frostbite, also known as freezing cold injury (FCI), is a type of skin damage that happens when the skin is exposed to temperatures below freezing. Frostbite is among a range of possible cold-related injuries, which includes less serious cases like frostnip. Any area of exposed skin can be damaged by frostbite. It could lead to severe damage to body tissue due to lack of blood flow (ischemic tissue) and potentially cause the tissue to die (necrosis).
Individuals who survive frostbite are vulnerable to secondary infections and dehydration because their skin’s protective barrier is compromised. Frostbite typically occurs when the body experiences extreme cold. This causes the blood vessels to constrict or narrow, restricting blood flow and hence heat delivery to tissues. This can eventually lead to the formation of ice crystals in the body tissue.
Parts of the body that are most at risk of frostbite include the feet, hands, ears, lips, and nose. Frostbite is most common in the winter months, and those most at risk are homeless individuals or people who spend a lot of time outdoors in cold temperatures. The main aim of frostbite treatment is to save as much of the affected tissue as possible to maintain the highest level of function.
What Causes Frostbite?
When skin is exposed to freezing conditions for a long duration or at very low temperatures, it can lead to frostbite. Frostbite, or injury caused by freezing of the skin and underlying tissues, can get worse if you have certain health conditions. These could include conditions that affect your blood vessels like peripheral vascular disease, nutritional deficiencies, Raynaud’s disease, diabetes, or if you use tobacco. All these conditions either make it hard for the body to stay warm or affect how blood vessels function.
There are various factors that can increase your risk of getting frostbite. These include:
- Being in cold weather conditions, especially in winter
- Lack of a shelter or having improper protection from the cold
- Being exposed to extremely cold wind
- Being in a high-altitude area
- Being exposed to cold and wet conditions for a long time
- Having a mental condition that alters perception
- Misuse of alcohol or drugs
- Being undernourished
- Being unable to move or immobilized
- Being very young or very old
- Being homeless
- Having health conditions like diabetes, underactive thyroid, diseases of the blood vessels, or arthritis
- Being a smoker
Remember to safeguard yourself from cold weather conditions to minimize the risk of frostbite, especially if any of the factors listed above apply to you.
Risk Factors and Frequency for Frostbite
Frostbite injuries used to be more commonly found in military personnel. However, with advancements in technology and increased participation in recreational sports, more cases of frostbite are appearing in these areas. People who are homeless, children, and elderly individuals are particularly susceptible to getting frostbite. Certain behaviors and conditions can increase the risk of frostbite. These include:
- Wearing insufficient clothing in cold weather
- Abusing alcohol or drugs
- Not having access to shelter
- Being dehydrated
- Being at high altitudes
- Experiencing hypoxia, a condition where the body or a region of the body is deprived of adequate oxygen supply
- Having health conditions such as diabetes, peripheral vascular disease, or Raynaud’s phenomenon that decrease tissue oxygenation.
Signs and Symptoms of Frostbite
If someone is suffering from frostbite, their medical history will need to include the duration of time they were exposed to cold temperatures. The physical exam usually reveals white, blanched skin and the patient may feel a heavy sensation in the area of the body that was exposed to the cold as the numbness sets in. The affected area might turn dark or purplish over time due to poor blood flow and the collection of blood under the skin.
There are different levels of frostbite. Superficial frostbite, which only affects the outer skin and its underlying fat, the skin might form pale, white blisters once it starts to warm up. On the other hand, severe full-thickness frostbite tends to form dark, blood-filled blisters during rewarming and might even turn into gangrene. The frostbitten skin is usually quite distinct from the healthy skin surrounding it.
Remember though, the initial examination does not provide the full extent or depth of the frostbite injury. More symptoms emerge as the area is rewarmed and heals.
- Swelling may start 3-5 hours into rewarming and can last for a week.
- Blisters usually form within the first day (4-24 hours).
- Scabs or eschars become visible after 10-15 days.
- The frostbitten area can start to mummify and a clear line separating the dead and healthy tissue usually forms in 3-8 weeks.
Testing for Frostbite
Frostbite can be identified by a doctor through a physical examination. If other health conditions might be worsening the frostbite, additional lab tests may be ordered. Dyes that show up on X-rays can be used in two tests called Technetium-99 triple phase scanning and magnetic resonance angiography. These tests can help doctors decide how much, if any, of your affected body part may need to be removed within a few days of injury. A bone scan with Technetium-99 can also help your doctor decide if you’re a good candidate for a medication called tPA.
Treatment Options for Frostbite
If you get frostbite, the first thing to do is protect the frostbitten area to prevent further harm. If you’re outside, get out of the wind, and remove any wet clothes and replace them with dry ones. Avoid rubbing your skin, as it can cause more damage.
The treatment at the hospital usually includes warm water baths of about 104 to 107.6 degrees Fahrenheit (approximately 40-42 degrees Celsius). If your body’s overall temperature is too low (hypothermia), the doctors will warm you up first with warm IV fluids before beginning to reheat the frostbitten area. These efforts are especially important if you have other health conditions or if you’re seriously injured. Over-the-counter pain relievers like ibuprofen can be used for pain and inflammation, but stronger painkillers may be needed.
Doctors carefully monitor the frostbitten area during the process. Even though it’s a bit controversial, some experts suggest draining clear, white blisters while leaving bloody ones alone. Just like in burns, the doctors’ priority is to prevent infections and dehydration. They avoid early surgical cleaning of the wound to prevent removing skin that might still be healthy. Your doctor will wait until your skin is completely warmed before doing this.
If your skin starts to swell, or you lose your pulse or experience intense pain, you should have surgery right away. These are signs of “compartment syndrome,” a severe condition that requires immediate attention. In some cases, it’s better to wait up to six weeks before deciding on amputation to avoid unnecessary procedures once it’s clear which areas are not going to recover.
Patients with severe frostbite and reduced blood flow who don’t respond to conventional warming treatments might be considered for drug therapy. A drug named tPA may be used to dissolve blood clots and improve blood supply and could potentially reduce the need for amputation. Another drug, Iloprost, may also be used to stop lack of blood supply in frostbite. However, it’s important to note that Iloprost is not available in the United States.
What else can Frostbite be?
It’s crucial for medical staff to properly examine patients who seem to have frostbite. This means checking for signs of overall body cooling and severe tissue damage. It’s equally important to consider and treat any underlying health concerns that come with frostbite, such as substance abuse, heart issues, exposure to harsh environments, or physical injuries. Neglecting these could result in serious overall health decline and even death.
What to expect with Frostbite
The outcomes of frostbite injuries vary based on how bad the tissue damage is. Issues like blood-filled blisters, non-fading blue or dark hues in the skin, and rigid skin after warming up, are all negative signs related to frostbite. It’s important for patients to stay clear of cold temperatures for a year after the injury.
Certain conditions can worsen the frostbite injury:
* Blood-filled blisters
* Lack of swelling
* Continued patchy skin discoloration
* Obvious presence of frozen tissue
Frostbite can lead to several complications, including:
* Unusual skin sensations
* Losing nails
* Reduced or excessive sweat production
* Dry, cracking skin
* Wasting of muscles
* Chronic pain
* Stiff joints
* Phantom pain, or feeling pain in an area that’s no longer there
* Shaking that you can’t control (tremor)
Possible Complications When Diagnosed with Frostbite
People who have experienced frostbite may find that the areas affected become unusually sensitive to cold. This condition often results from abnormal responses of the blood vessels and nervous system to cold temperatures following the injury. Complications might include a condition named complex regional pain syndrome. In some cases, the affected finger or toe might fall off by itself before any surgical removal is needed.
Common Side Effects:
- Sensitivity to cold in previously frostbitten areas
- Abnormal responses of blood vessels and nervous system to cold
- Complex Regional Pain Syndrome
- Autoamputation (finger or toe falling off on its own)
Preventing Frostbite
Reducing the risk of frostbite is crucial, especially for those living in chilly climates. This involves dressing appropriately, finding shelter when necessary, and maintaining healthy eating and drinking habits. If you anticipate exposure to the cold, patients should wear layered clothing and ensure they stay as dry as possible. People are also advised to avoid consuming alcohol as it can increase your risk of frostbite. Regardless of popular belief in Nordic countries, creams or lotions have been shown to not offer any protective benefits against frostbite and therefore should not be relied on for defense.
