Frostbite Treatment and Prevention: FAQ

An expert offers tips for preventing and treating frostbite.

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

Dec. 24, 2008 -- Baby it's cold outside, with icy, wintry weather settling in from the Pacific Northwest to New England.

So how do you make sure that when Jack Frost nips at your nose you don't end up with frostbite?

Plan ahead to make sure you're prepared for the winter weather, emergency medicine specialist Thomas Tallman, DO, tells WebMD.

Tallman has seen more than his share of cold-weather injuries as a staff physician at the Cleveland Clinic's Emergency Services Institute and as an on-call doctor at the football games of the Cleveland Browns.

"When you're wet or exposed to high winds, core body temperatures can drop quickly and you can get into trouble pretty fast," he says.

What is frostbite?

Frostbite is literally the freezing of body tissue (usually skin). Fingers, toes, ears, and the nose are the areas most vulnerable to frostbite.

There are three degrees of frostbite, including:

• Frostnip, which usually affects the face, ears, or fingertips. While the skin may feel numb, frostnip does not lead to permanent tissue damage.
• Superficial frostbite, in which the outer skin is affected.
• Deep frostbite, in which the skin and underlying tissue freezes. Permanent damage is possible, depending on how long and how deeply the tissue is frozen.

Frostbite is caused by either prolonged exposure to cold temperatures or shorter exposure to very cold temperatures.

What are the symptoms?

Many people with frostnip or frostbite experience numbness. A "pins and needles" sensation, severe pain, itching, and burning are all common when the affected area is warmed and blood starts flowing again.

Skin may look white, grayish-yellow, or even black with severe frostbite, and it may feel hard, waxy, and numb. Blistering is also common.

Who is at risk?

Anyone can end up with frostbite if exposed to frigid conditions for too long. Naturally, those who work outside in the cold or engage in cold-weather sports may be vulnerable if they aren't adequately prepared.

But some people are also more susceptible to extremely cold weather than others, including:

• The very young and the very old.
• Diabetes patients and people with other medical conditions associated with poor circulation.
• People with heart conditions who take beta-blockers, which decrease the flow of blood to the skin.
• Those who smoke and/or drink alcohol while exposed to cold weather.

Wearing wet clothes, not wearing enough clothes, and exposure to high winds increase vulnerability.

Even people who think they are prepared for the cold weather may not be, Tallman says. He recalls one Browns game last season which started in the rain and ended in an icy snowstorm.

"Many of the tailgaters got pretty soaked before the game and then when the temperatures dropped they got into trouble," he says.

What are the treatments for frostnip/frostbite?

Get out of the cold and get out of wet clothing as soon as possible and remove all constrictive jewelry and clothing. Then immerse the affected area in warm, but not hot, water.

If water is not available, warm the tissue with body heat. For example, warm your hands by tucking them into your armpits and warm your nose, ears, or face by covering them with dry hands.

"Warm water is the gentlest and safest way to warm frostbitten skin," Tallman says.

Do not:

• Thaw the frostbitten tissue if there is a chance that it will refreeze before you get medical attention, as this increases the likelihood of permanent damage.
• Rub or massage frostbitten skin or disturb blisters, which can further damage tissue.
• Use direct dry heat, like heating pads or a campfire to thaw frostbitten tissue.

Many people with frostbite may also be experiencing hypothermia (body temperature that is too low), which can be deadly. This is why it is so important to seek medical attention immediately.

How can I stay safe?

Extreme cold, high winds, wet clothing, and poor planning all contribute to cold-weather injury.

If you are planning outdoor activities, check weather forecasts frequently and don't ignore warnings about storms and other inclement conditions. Avoid sports activities -- such as hiking or camping in freezing weather -- that are beyond your experience level.

Also:

• Wear adequate clothing. Tallman recommends wearing several layers of clothing, with the innermost layer being a fabric that wicks moisture from the skin. The outer layer should serve as a windbreaker.
• Mittens provide more protection than gloves. Wearing two pairs of socks is advised, with wool recommended for the outer later. And don't forget a hat and scarf that covers the ears.
• Get moving. Increasing physical activity will help your body stay warm. Wiggle fingers and toes if they start to feel numb.
• Don't drink alcohol before or during cold weather exposure, since alcohol may prevent you from realizing that your body is becoming too cold.
• Don't smoke. Smoking constricts blood vessels and increases the risk for frostbite.

"It is a good idea to keep a cold-weather emergency kit in your car with extra layers of clothing, a blanket, and some of those chemical hand warmers," Tallman says. "It is important to plan ahead and be prepared."

SOURCES: WebMD Medical Reference: "Understanding Frostbite." Thomas Tallman, DO, staff physician, Emergency Services Institute, Cleveland Clinic. WebMD Medical Reference From Healthwise: "Cold Temperature Exposure."

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