With winter finally having arrived in the Northeast, I thought it a good time to review frostbite: what it is, what to look for, how to avoid it – and the dangers of not properly treating it.
Frostbite itself is typically proceeded by frostnip, something that happens when your skin has been exposed to temperatures of 32° Fahrenheit or less. With frostnip, your skin may turn noticeably pale or red and feel cold, though there is no tissue damage associated with it. Usually treating frostnip is as simple as getting indoors and warming up.
If frostnip progresses to frostbite, however, there can be a variety of reasons for concern. Frostbite can take place in as little as 5 to 10 minutes, depending on the temperature and other wintry conditions. In such conditions, the body slows blood flow to the skin in order to send more blood to one’s vital organs. As a result, frostbite is most likely to occur in such extremities as the cheeks, nose, ears, fingers, and toes.
There are four stages of frostbite. With first-degree cases, your exposed skin may feel numb, tingly or otherwise irritated; with second-degree frostbite, you may notice purple or blue areas on the skin after warming back up. You may also develop fluid-filled blisters in the affected area(s) after a day or so. Second-degree blisters may be drained, but use caution: without a doctor’s supervision, you may run the risk of infection.
With severe or deep frostbite – third- and fourth-degree – professional medical help is strongly advised. Third-degree involves the layers of tissue below the skin freezing, resulting in blue-grey discoloration of the skin and the formation of dark, blood-filled blisters. Those blisters should by no means be drained by anyone other than a medical professional; even they may elect to leave such blisters alone to avoid causing further damage to blood vessels in the affected areas. You may also experience the sloughing off of dead skin tissue (called “eschar”), similar to what happens with victims of severe burns and other conditions. This is indicative that permanent tissue damage may have taken place.
Fourth-degree frostbite includes not only numbness but also the potential for joints and muscles to stop working as the bones and tendons freeze. Large, black blisters form within 24-48 hours of rewarming, and the tissue turns black and hard as it dies. In such cases, your healthcare provider may decide to surgically remove any dead skin and tissue; in the worst-case scenario, amputation of the affected fingers and/or toes may be necessary.
Avoiding the Worst
Thankfully, third- and fourth-degree cases of frostbite are extremely rare, especially in this area of the country. Those most at risk of developing frostbite of course include anyone who is exposed to sub-freezing temperatures for long periods of time. These include anyone stranded in extreme cold; mountaineers, skiers and other winter sports enthusiasts likely to be participating at high altitudes; those working outdoors in severe conditions for long periods, such as military personnel and rescue workers; and homeless people.
For those of us who have been shoveling snow, sledding, or going on hikes in the cold, once numbness or “pins and needles” is apparent, getting inside to a warmer space can return you to normal fairly quickly. Running your hands under warm – never hot – water can also help, though you should avoid warming yourself by a fire or rubbing your hands, which can cause further tissue damage. Any wet clothing should be removed.
While many of us are unlikely to get frostbite at all, it is important that you dress appropriately during the winter (coat, hat, gloves, boots) and know the signs and symptoms so you can seek help before frostbite sets in. If symptoms persist, or if you are unsure of whether you’re suffering from frostbite, call your physician ore go to the emergency department for a consultation.
Dr. Matthew Zeppieri is a family medicine physician at White Plains Hospital Physician Associates of New Rochelle. For an appointment, call 914-235-8224.