Frostbite: How to Avoid and Treat, Winter 2015 Newsletter

With the rapidly approaching winter weather, we are frequently reminded of how to prepare our homes and cars, but there is usually little advice on how to protect our skin from the cold. Common sense dictates that we all should bring out our winterwear, but for those of us who work or play hard during the winter weather, more serious measures are required. There are two potentially serious skin conditions that can result from extreme winter cold exposure. The most serious, but less common, is frostbite.

We have all heard of frostbite, but fortunately, most people never experience its potentially devastating effects. Frostbite occurs when exposed tissue reaches the freezing point, and skin, blood vessels, nerves, and muscles are damaged. Frostbitten skin may appear white or red and is usually numb. Just as with burns, frostbite exists to varying degrees. In minor cases (known as frost nip), complete recovery is possible. In moderate cases, the skin may blister. In extreme cases, frostbite may result in the amputation of digits or even limbs.

The prevention of frostbite includes maintaining body heat in the peripheral regions, including fingers, toes, ears, and nose. This includes insulating these areas against cold exposure, but also making sure that the body core maintains a normal temperature. If the body core temperature drops too low, our vascular system will decrease circulation to our limbs to ensure survival. This helps to maintain our core temperature, but unfortunately, the decreased blood flow to our limbs rapidly increases the risk for frostbite.

Here are some tips to prevent frostbite:

  • Dress in multiple layers. Keep the layer closest to the body covered with material that can wick away sweat.
  • Completely cover all surfaces, especially ears, scalp, neck, toes and fingers.
  • Wear mittens, which are warmer than gloves.
  • Wear socks that wick moisture and are not tight in the boots. Too thick socks can cause impairment of circulation.
  • Don’t drink alcohol before going out in extreme cold. It dehydrates you and also makes you
    less vigilant.
  • Tell others when you will be back, so they can come to look for you is you don’t return.
  • Keep moving to stay warm, no matter how
    cold you feel.

Once frostbite occurs, treatment involves gradually returning the affected tissue to normal body temperature. Frostbite is considered an emergency situation and is best handled in the emergency department. However, if frostbite must be treated in the field, affected areas should be immersed in tepid or body-temperature water (even cold water will be warmer than the affected part). If water is unavailable, frostbitten skin should be placed in a warm area such as the underarm of an unaffected person. DO NOT place frostbitten skin in hot water, as this may result in further harm to the tissue.

A much more common, though less serious, winter skin condition is cold-induced urticaria. Some people may develop itchy hives or welts on exposed skin during the colder months. In more severe cases, exposed areas may swell and become painful. People who are susceptible to cold-induced hives will usually benefit from over-the-counter antihistamines such as cetirizine (Zyrtec®). Affected individuals should certainly protect against the cold, but pre-treating with an antihistamine will almost always prove beneficial.