By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

“NUMBNESS” OR “TINGLING” ARE BODY’S WARNING SIGNS OF FROSTBITE

Question: It gets very cold where my family and I live now, and we all love the outdoors. Can you tell me about frostbite, how to treat it and how to prevent it? We are new to this cold climate, and I have heard many stories about frostbite.

Answer: Frostbite is damage to the skin and underlying tissues due to extreme cold. It involves the actual freezing of body tissues after exposure to cold temperatures -- usually after a prolonged period. Exposed body parts, such as hands, ears, nose and feet are the most common areas affected. Since children are more prone to frostbite than young adults, it is important to dress them properly and monitor them when playing outdoors.

Frostnip is an early stage of frostbite that occurs when only the surface layer of the skin is frozen. This can be managed at home by removing wet clothing and rewarming the body parts in slightly warm -- but not hot -- water. Often the affected parts are numb, so it is important to have someone else check the water temperature to prevent burning.

True frostbite, on the other hand, is a medical emergency and requires treatment at the nearest hospital emergency department. Frostbitten skin appears white and waxy and feels harder than normal. In the early stages, you may have the sensation of “pins and needles” in the affected body part. As the condition progresses, this may be followed by numbness as well as throbbing or aching. In later stages, all of the deep structures become frozen -- including the muscles, tendons, blood vessels, and nerves. You will lose all sensation in the affected extremity. It will also have a “woody” feeling.

If the freezing is not too severe, blisters can appear over the damaged area a day or so after the frostbite incident. In the most severe cases, blistering does not occur. In these cases, surgery -- including amputation of permanently damaged areas -- may be required.

Prior to going to the emergency department, you should try to get out of the cold and remove wet clothing. Try to warm up as much as possible, since frostbite victims also often have hypothermia (low body temperature). Gently rewarming a frozen part in 100 degree water is the appropriate initial therapy, providing you can keep the part from refreezing. Don’t rub a frozen part or use excessive heat to rewarm an area while awaiting medical help.

The best treatment for frostbite and frostnip is prevention. Dress in layers when going out. Avoid spending extended time in the extreme cold. Protect susceptible areas such as your hands and face. Wear well-fitting, waterproof boots and clothing. Avoid drinking alcohol, which causes you to lose more body heat, and smoking, which reduces circulation to the extremities.

Some people with peripheral vascular disease, poor circulation and those taking certain medications like beta-blockers are more prone to frostbite. Also if you suffer from diabetes, you are at increased risk.

All of us should be aware that frostbite risk increases even in mildly cold weather if it is a windy day. This is why your local weather person reports the “wind chill” factor during the winter months.

One final tip: listen to your body. Anytime you feel tingling or numb sensations in an extremity, get to a warm indoor area as quickly as possible.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.