The condition known as frostbite occurs when the skin and underlying tissues freeze in response to being exposed to extremely cold temperatures. Despite the fact that it can affect any part of the body, it is more common in the extremities, including the fingers, toes, ears, nose, cheeks, and chin. A patient who is left untreated with frostbite may suffer permanent damage to their skin, nerves, blood vessels, muscles, and bones.
When exposed to cold temperatures for a prolonged period of time or by contacting cold objects or substances, such as ice, snow, metal, or liquid nitrogen, a person develops frostbite. The cold causes the blood vessels in the affected area to constrict, reducing blood flow and oxygen supply. The result is damage to the tissues and cell death. The following factors increase the risk of frostbite:
Wearing inadequate or wet clothing
Having a medical condition that affects blood circulation, such as diabetes, Raynaud’s phenomenon, or peripheral arterial disease
Taking medications that constrict blood vessels, such as beta-blockers or nicotine
Consuming alcohol or drugs that impair judgment or sensation
Being dehydrated or malnourished
Being elderly or very young
The symptoms of frostbite depend on the severity and stage of the condition. There are four stages of frostbite:
Frostnip: This is the first and mildest stage of frostbite. The affected area becomes cold, numb, and pale. The skin may also feel prickly or tingly. There is no permanent damage at this stage and the symptoms usually resolve after warming up the area.
Superficial frostbite: This is the second stage of frostbite. The affected area becomes hard, waxy, and white or grayish-yellow. The skin may also blister and peel. There may be some permanent damage to the skin and nerves at this stage.
Deep frostbite: This is the third and most severe stage of frostbite. The affected area becomes black or blue and loses all sensation. The skin may also crack and fall off. There is extensive damage to the skin, nerves, blood vessels, muscles, and bones at this stage. Gangrene (tissue death) may develop and amputation may be necessary.
Hypothermia: This is a life-threatening condition that occurs when the body temperature drops below 35°C (95°F). Hypothermia can cause confusion, drowsiness, slurred speech, shivering, slow breathing, weak pulse, and loss of consciousness. Hypothermia can occur along with frostbite or independently.
Frostbite can be diagnosed by examining the affected area and asking about the history of exposure to cold. Some tests that may be done to assess the extent of damage are:
Thermography: This is a test that uses infrared imaging to measure the temperature of the skin. It can show areas of reduced blood flow and tissue damage.
X-ray: This is a test that uses radiation to create images of the bones. It can show fractures or deformities caused by frostbite.
Bone scan: This is a test that uses a radioactive substance to highlight areas of bone activity. It can show areas of infection or inflammation caused by frostbite.
Magnetic resonance imaging (MRI): This is a test that uses a magnetic field and radio waves to create detailed images of the tissues. It can show areas of tissue damage or necrosis caused by frostbite.
Treatment for frostbite depends on the severity and stage of the condition. The main goals are to prevent further damage, restore blood flow, reduce pain and inflammation, prevent infection, and preserve function.
To treat frostbite, it is important to rewarm the affected area gradually in warm water (40°C to 42°C) for 15 to 30 minutes, or until it becomes red and soft. In order to prevent complications such as burns and shock, rewarming should be performed under medical supervision.
Debridement involves removing dead or damaged tissue from the affected area. Debridement can be done surgically or with enzymes or dressings.
Medications used to treat frostbite include:
Painkillers: These are drugs that relieve pain and discomfort. They may include ibuprofen, acetaminophen, or opioids.
Vasodilators: These are drugs that dilate (widen) blood vessels and improve blood flow. They may include iloprost or pentoxifylline.
Antibiotics: These are drugs that fight infection and prevent complications. They may include penicillin, erythromycin, or clindamycin.
In surgery, damaged tissue or bone is repaired or removed from the affected area. It may be used to close a wound, graft skin, reconstruct blood vessels, or amputate limbs.
Rehabilitation involves restoring function and mobility to the affected area through physical therapy, occupational therapy, or prosthetics. Rehabilitation can take weeks, months, or years depending on the extent of the injury.
Frostbite can be prevented by taking some precautions when exposed to cold temperatures or substances. Some tips to prevent frostbite are:
Dress appropriately for the weather. Wear layers of warm, dry, and breathable clothing. Cover exposed areas such as the head, face, hands, and feet. Wear mittens instead of gloves.
Take frequent breaks in warm places. Limit time spent outdoors and avoid contact with cold objects or substances such as ice, snow, metal, or liquid nitrogen.
Avoid alcohol and caffeine as they can impair blood circulation and increase heat loss. Stay hydrated and eat high-calorie foods.
If you suspect frostbite or hypothermia, seek medical attention immediately. Monitor yourself and others for signs of frostbite.
