Frostbites occur when ice crystals form within body tissues following exposure to the cold, thus damaging skin structures. While all skin surfaces are at risk, whether they are exposed to the cold or covered by clothing, frostbites are most common on the cheeks, nose, fingers and toes. The severity of frostbites mainly depends on the length of exposure to the cold and on the amount of time the limb remains frozen.
Strong winds and high humidity levels increase the effects of cold temperatures and accelerate the cooling of the body, which increases the risk of frostbites. The risk is also higher when the clothing worn is inadequate, when individuals have already had frostbites, and when they smoke or have consumed alcohol.
Mild frostbite occurs when the skin whitens but only the skin’s superficial layer – the epidermis – is frozen. If the skin is quickly warmed, using one’s hand, for example, the epidermis’ normal coloring will return and the skin will not be damaged. It is vital to act quickly, because in the 30 to 60 minutes following the first signs of mild frostbite, a more severe form affecting deeper layers of the skin will form if the skin remains exposed to low temperatures without any protection.
When true frostbites develop, skin is white and waxy, yellowish or bluish, in addition to becoming harder to the touch and causing a gradual loss of sensation. If you experience this degree of frostbite, return indoors as quickly as possible and remove any clothing that is wet or that might hinder blood circulation. Above all, do not rub the skin, as this may further damage the skin tissues!
If you cannot immediately begin warming the limb and be certain that it will remain warm, keep the limb away from any source of heat. Warming a frozen limb followed by a return to intense cold could aggravate the tissue damage. You must therefore be absolutely sure that the person can be kept warm once the warming process is initiated.
The classic technique for warming cold hands and feet is to place the affected person’s fingers under someone else’s armpits or groin, since these body parts are always warm. Toes will also warm up quickly if bare feet are placed on a brave volunteer’s belly. While these techniques are not always pleasant for the person doing the warming, they are very effective and particularly convenient with children.
The affected limb can also be soaked in lukewarm water (40 to 42°C) for 10 to 30 minutes, until the limb becomes red and is once again supple. Once the area has thawed, keep the limb elevated and apply clean, dry gauze to protect the skin.
Pain, swelling, redness and an intense burning sensation often occur during the “thawing” period. An analgesic such as ibuprofen or acetaminophen may relieve the pain. If the pain persists for more than 24 hours, it would be advisable to see a doctor.
The complications associated with frostbites can only be assessed after the limb has thawed. In cases of mild frostbite, the skin regains its regular appearance. Blisters filled with a clear liquid may appear within the 6 to 24 hours following frostbites; these are a normal response from the body to protect itself. Whenever possible, it is best not to burst these blisters. They disappear on their own within a few days as the body reabsorbs the liquid. In cases of more severe frostbites, the skin remains white or turns a bluish-grey, forms dark blisters, and there may be a loss of sensitive perception.
See a doctor if large blisters form, especially if they are filled with a whitish or blackish liquid, and if the pain caused by the frostbite is not controlled using normal analgesic doses after 24 hours. The consequences of severe frostbites are not to be dismissed: a tickling or burning sensation may persist for weeks following such a case, while increased sensitivity to the cold, loss of sensation in the affected area, a change in skin pigmentation, deformed nails and excessive sweating may persist for years. Severe frostbites can also lead to gangrene and amputation if the affected tissues are deprived of blood for a sufficiently long period of time.
An ounce of prevention is worth a pound of cure! Make sure you drink regularly during your outdoor activities. Adequate hydration helps maintain better blood circulation and therefore helps keep extremities warm.
When planning an extended outdoor activity, think of keeping your feet and hands dry by choosing socks made of synthetic fibres. Opt for mittens rather than gloves, as fingers joined together will stay warm longer, and wear several layers of clothing so that you can add or remove a layer depending on your level of activity.
The base layer, in other words the one closest to the skin, must repel humidity and keep the body warm. Cotton is not recommended, as it absorbs perspiration and dries very slowly. Synthetic microfibres are much better for this thin base layer. You should then add a second insulating layer made up of a natural wool or polar fleece sweater, for example. The outer layer (e.g. raincoat, windbreaker or down-filled jacket), for its part, offers protection against the wind or rain and provides an additional layer of insulation.
When going on an extended outing, remember to bring extra mittens and socks, along with another insulating layer such as a wool sweater. Pocket warmers can also be useful in very cold temperatures. When slipped into mittens or on top of feet, they are a great help in preventing the cooling of extremities for a few hours.
Are you initiating your young children to the joys of winter? Don’t forget that their skin is especially sensitive to the cold. Since a baby’s skin is very thin and fragile, it’s important to protect it well in order to avoid dryness, fissures and frostbites. To avoid these problems, keep the baby’s skin well hydrated using a fragrance-free and non-allergenic lotion, and apply a balm to his or her lips in order to prevent chapping.
Winter is a wonderful season for those who know how to dress properly and protect themselves from the cold – preparation that makes almost any outdoor activity feasible. The rest is in your hands: if one of your limbs becomes numb or tingly, and in addition you notice the skin is pale, it’s time to go back in or at least to warm up a bit. Frostbites can appear insidiously, so it’s important to remain vigilant!
Outdoor equipment shops are usually a good place to look for more information on the proper clothing to wear for winter activities. As for frostbites, don’t hesitate to consult your pharmacist if you have any questions on the subject.