What do ice fishers, small babies and the homeless have in common?
They are all at increased risk for frostbite. Anyone with excessive exposure to cold is at risk: ice fishers or hunters sit for prolonged periods in the cold; babies are poor at generating heat and obviously are unable to say when they are cold; and the homeless may be inadequately dressed and have no warm shelter. Also at greater risk of frostbite: outdoor workers, joggers and winter enthusiasts who may get overly chilled with sweaty outfits, and any person who drinks alcohol (excessively or not) because alcohol increases heat loss through our skin and impairs our judgment.
What is the difference between frostnip and frostbite?
Frostnip happens when an extremity cools down until it is tingling but not freezing, hence it does not cause permanent damage. Frostbite is when a part of the body actually freezes. Ears, noses, cheeks, fingers and toes are most at risk. In order to keep the body’s core temperature up, blood is shifted towards vital organs. Symptoms of frostbite include an initial cold sensation which can progress to prickling and itching and then to numbness with stiff, pale, white skin.
Do I need to see a doctor to treat frostbite or other cold injury?
It is safest to be seen by a medical professional to treat cold injury. People who are hypothermic (their body temperature is too low) may show lack of clear judgment and should be brought to the emergency department for immediate treatment. Treatment includes removing wet gloves or clothes, and slowly warming the affected areas with dry clothes, warm blankets or tepid water. The warming process can be quite painful. In addition, if there is no way to stay warm, it is best to postpone thawing frozen body parts. Recurrent freezing and thawing can cause irreparable damage to the body part. If the frostbite is severe, the body part can be damaged beyond repair and turn gangrene. Gangrene can lead to the loss of the affected finger, nose or toes.
Do people fully recover?
Some people develop an extreme sensitivity to cold and can get trigger reactions (Raynaud’s phenomenon) anytime they are exposed to cold. Nerves can become quite sensitive and can cause pain, altered sensation or excessive sweating of the skin on the affected area. Anyone who has been frostbitten does end up being more susceptible to further cold injury. In other words, once someone has been frostbitten, they are more likely to be frostbitten again.
How do I avoid cold injury?
The bottom line is it is better to prevent frostbite with adequate cold protection. All babies should have one additional layer of clothing than an adult would need to stay warm. Generally, it is safer to use a scarf, gator or balaclava than put protective ointments on cheeks. Waterproof mittens are better than gloves, and a hat will minimize heat loss out of your head. Bring extra dry clothes if doing outdoor winter activities. Remember that a ‘nip’ of alcohol only makes you feel warmer while making your body lose more heat. If you feel you need a nip to keep warm, you may already be at risk for cold injury!
Alicia Jacobs, MD, family medicine physician, is Vice Chair of Clinical Operations in Family Medicine at The University of Vermont Medical Center. She is also practices at Family Medicine Colchester.