• Dr. Lauren O'Byrne

Frostbite

As the temperatures decrease, the likelihood of developing frostbite increases.

Frostbite results from the freezing of tissue. The tissue destruction is due to both immediate cold-induced cell death and the more gradual development of localized inflammatory processes after the thawing of affected tissue. Areas most frequently affected by frostbite include the ears, nose, cheeks, chin, fingers, and toes. It is most often encountered in mountaineers and other cold weather enthusiasts, those who work in the cold, the homeless, and individuals stranded outdoors in the winter.

There are four degrees of severity based upon the depth of tissue involvement:

  1. First-degree frostbite is very superficial and has a central area of paleness and numbness of the skin surrounded by swelling

  2. Second-degree frostbite has large blisters containing clear fluid surrounded by swelling and redness, developing within 24 hours and extending to or nearly to the tips of digits. The blisters may form a black scar, but this later sloughs off, revealing healthy healing tissue

  3. Third-degree frostbite differs from second-degree in that the injury is deeper and the blisters are smaller, bleeding and closer to the body. The skin forms a black scar in one to several weeks

  4. Fourth-degree frostbite, which extends to muscle and bone, involves complete tissue destruction. Typically, this tissue does not recover

Risk factors for developing frostbite and cold-induced injury include any condition that increases localized heat loss or decreases heat production. Examples include:

  1. Increased heat loss due to exposure to wind or due to contact with metal, the ground or water

  2. Exhaustion, dehydration, malnutrition, or comorbidities such as peripheral vascular disease, diabetes or mental illness may limit an individual’s ability to respond to a cold stress

  3. Alcohol abuse: acute behavioral changes that may impair judgement, increased heat loss from blood vessel dilation, and chronic complications of alcohol consumption

  4. Other sedating or judgment impairing drugs or medications

  5. Low ambient temperatures

  6. Increased wind chill effects

  7. Higher altitudes

  8. Direct exposure to freezing materials like the application of ice packs to reduce swelling from musculoskeletal injuries. It is important to interpose a cloth between the ice pack and skin and limit treatment intervals to 20 minutes with a minute or two break between applications.

Frostbite generally develops within minutes to hours depending on circumstances and risk factors. If you have concerns about frostbite, it is important to seek care immediately.

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