Is that why your fingers are blue?

You’re enjoying a walk outside, but after a little while, your fingers start to tingle and feel slightly numb. You don’t have anything to cover your hands with, so by the time you get back inside, your hands are very red with some whiteish color near the tips. You figure that you have some level of frostbite. How do you safely rewarm your hands? Should you be concerned about permanent damage?

FrostbiteDefinition

Frostbite is what happens when your skin and underlying tissues freeze. Usually, it’s caused by exposure to cold-weather conditions. If you don’t wear clothes suitable for the conditions and/or stay out in the cold and wind for too long, your chances of developing it increase drastically. In a wind chill of -16.6°F, frostbite on exposed skin takes place in less than 30 minutes. The condition can also occur by having direct contact with ice, frozen metal, or very cold liquids. Frostbite is most common on the fingers, toes, nose, ears, cheeks, and chin. Even if you’re wearing protective clothing, frostbite can still happen.

Symptoms of frostbite are cold skin and prickling feeling at first, followed by numbness, red/white/bluish-white/grayish-yellow skin, hard/waxy-looking skin, clumsiness due to joint/muscle stiffness, and blistering after rewarming (severe cases). Frostbite has several stages. The first is frostnip, which is mild and doesn’t permanently damage the skin. Typically, this is reddened skin that is cold and becomes numb. As the skin warms, it’s painful and tingling. Superficial frostbite is when the skin turns white/pale and the skin actually feels warm (a sign of serious skin involvement). If you warm the skin, it’ll appear mottled and you’ll notice stinging/burning sensation and swelling to the area. Sometimes, a fluid-filled blister appears 12–36 hours after rewarming. Deep, or severe, frostbite affects not just the skin but the tissues underneath it. In this stage, your skin will look white or bluish-gray and the area may feel numb or lose all sensation. Also, your joints and muscles may not work. After rewarming, large blisters appear within 24–48 hours before the area turns black and hardens as the tissue dies.

Certain factors can increase your chances of developing frostbite. These can include medical conditions that affect your ability to feel/respond to cold (ex. dehydration, excessive sweating, exhaustion, diabetes, and poor blood flow in your limbs), alcohol/drug abuse, smoking, fear/panic, mental illness, previous frostbite/cold injury, being an infant or older adult, (they have a harder time producing and retaining body heat), and being at high altitude (reduces the oxygen supply to your skin). Frostbite can result in serious complications, such as increased sensitivity to cold, increased risk of developing frostbite again, long-term numbness in the affected area, excessive sweating (hyperhidrosis), changes in skin color, changes in/loss of nails, joint stiffness (frostbite arthritis), growth defects in children (if frostbite damages a bone’s growth plate), infection, tetanus, gangrene (decay/death of tissue resulting in the amputation of the affected area), and hypothermia.

You should seek medical help for frostbite if you have any symptoms of superficial or deep frostbite, increased pain/swelling/redness/discharge in the frostbitten area, fever, or new/unexplained symptoms. While waiting to get help, protect the affected area from further cold exposure, don’t walk on frostbitten feet, and reduce pain with ibuprofen. You should get emergency medical help if you think you have hypothermia, which would present with intense shivering, slurred speech, drowsiness, and loss of coordination.

TreatmentFast Facts - Frostbite

Frostbite that is minor, like frostnip, can be treated at home with basic first-aid techniques. Most people find that after rewarming, putting aloe vera gel or lotion on the area several times a day is helpful. For all other types, it’s important to assess for hypothermia and do any necessary first aid before being treated at a hospital. The treatment level depends on severity but usually includes rewarming, medications, wound care, and surgery, if needed. Rewarming involves submerging the area in warm water for 15–30 minutes. During this, the skin might be red or purple in color and soften. Sometimes, the doctor will encourage you to move the area gently. Since this process can be painful, the doctor will give you medicine to help alleviate it. After the area is warmed, it’s necessary to protect the skin by wrapping the area in sterile towels or dressings. To aid in swelling reduction, you might need to elevate the affected area.

The damaged, dead, or infected tissue needs to be removed from the affected area for it to heal properly. One option is to soak in a whirlpool bath because this naturally removes dead tissue. Another solution is to have it surgically removed. Your doctor will help you decide the best method for wound care, depending on your condition. If the area becomes infected, you’ll need to take antibiotics. For severe frostbite where there is concern about possible amputation, your doctor may suggest intravenously injecting medication that helps restore blood flow, or clot-busting drugs (ex. tissue plasminogen activator—TPA). These pose a very serious risk of bleeding, so they aren’t used unless the damage is critical and it’s within 24 hours of exposure.

After developing any level of frostbite, there are a few key things to remember. The most important is to avoid further exposure to the cold and wind. It’s also essential not to apply direct heat or rub the area. If your feet are affected, don’t walk on them. Any items that are tight, including rings, should be taken off in case of swelling. If you’re having any discomfort, try over-the-counter pain medication, like ibuprofen, to reduce pain and inflammation. If blisters develop, don’t pop them since this can lead to infections.

Prevention

Frostbite can be prevented, provided you take the right action. The first step is to know the weather forecast so you’ll know how to dress. When putting on clothes, it’s key to wear several layers that are loose and warm. By keeping air trapped in between the layers, it acts as insulation against the cold. Undergarments should wick away moisture from your skin, while outer garments should be windproof and waterproof. If your clothing gets wet, change out of it as soon as possible. Another thing to remember is to wear a hat or headband that covers your ears. Mittens are better than gloves because they allow your fingers to be together, retaining body heat. Socks that wick away moisture while providing adequate insulation is vital. You can also use hand and foot warmers in your mittens and boots.

After making sure you’re appropriately dressed, limit the amount of time you spend outdoors in cold, wet, or windy weather. Keep moving because this helps to get your blood flowing and helps you to stay warm—just don’t overdo it. Watch for signs of frostbite and if you notice any, go inside. Avoid drinking alcohol when you’re outdoors in cold weather since it causes you to lose body heat faster. Before going out in the cold, eat well-balanced meals and stay hydrated. If you’re traveling in cold weather, make sure you have emergency supplies and warm clothes with you in case you become stranded.

Frostbite can be very serious, which is why you should do everything that you can to prevent it. If you have any questions or concerns about frostbite, please speak with your doctor. If you would like more information, please visit MedlinePlus’ frostbite page at https://medlineplus.gov/frostbite.html