March 14, 2017

How to avoid frostbite

Winter in Wisconsin means snow, cold temps and even a “polar vortex” or two. And along with the Arctic temps comes the very real risk of frostbite. Frostbite can happen more quickly than many realize.

When the temperature outside is 0 degrees, and the wind speed is 15 mph, exposed skin can freeze in 30 minutes. Colder temps and higher wind speeds mean even less time – as little as 10 minutes. And for kids that time may be even less as they lose heat more rapidly than adults.

What happens when skin is exposed to cold temps is that the skin and the tissue directly underneath freeze. Dr. Apple Bodemer, UW Health dermatologist, explains that initially the exposed skin will feel cold and “tingly”, then it will become numb.

“The skin might look white and waxy, and even feel hard,” she said. “Blistering can occur, and in severe cases the damaged skin and tissues can turn black.”

Risk factors for frostbite

While exposure to cold – especially in windy conditions - is the main risk factor, there are other factors that can increase the risk, including:

  • Exposure to cold water or metal

  • Dehydration or malnutrition

  • Peripheral vascular disease (when the blood vessels don’t function normally)

  • Diabetes (damaged nerves, or "nerve neuropathy," can make it harder to recognize early signals of frost bite)

  • Mental illness

  • Alcohol (alcohol can impair judgment and reaction time. It also causes blood vessels to dilate, which increases heat loss)

  • Smoking (affects peripheral blood vessels, or those blood vessels located in hands, arms, feet and legs)

  • Prior cold injury

Frostbite prevention

The best and easiest prevention for frostbite is protection from the elements. Pay attention to weather forecasts and plan accordingly. Even if you’re not planning to be out for long periods of time, Dr. Bodemer said it is still important to dress for the weather.

Start with multiple layers – a loose “wicking” base layer (long underwear) followed by an insulating second layer and last a windproof/waterproof out layer (winter coat, snow pants). And of course insulated winter boots.

Consider two pairs of socks and if you’re going to be out walking or working in the temps, make sure snow cannot get into your boots.

Hats – especially ones that cover the ears – face masks, mittens, sun glasses (or goggles) should cover your face.

That moisture “wicking” base layer can help keep your body dry and cool. All of that gear can cause you to sweat, but too much sweat can make dehydration worse.

Avoid alcohol when spending time outdoors in cold weather. It may give you a temporary sense of warmth, but ultimately it decreases awareness, impairs reaction and causes vasodilation (the blood vessels open or “dilate,” which increases your body’s heat loss).

“Some people use lotions or ointments on the skin to prevent frostbite, but these creams actually make frostbite more likely,” said Bodemer.

And for kids – while they may be reluctant to come inside if they are playing outdoors, it is important that they take a break from the cold. And if they are walking to school or waiting for the bus, dressing appropriately for the cold temps – even if they object – is critical for their safety.

Treatment for frostbite

Dr. Bodemer explains that if you think you might have frostbite, move to a warmer place as soon as you can and remove any wet clothing. If sensation doesn’t come back to the skin, or the skin turns gray, seek medical help.

If you do experience frostbite, Dr. Bodemer notes that it is important to avoid using the injured area as it can increase the injury to the tissue. If feet are involved, this can be tricky since it’s hard to avoid walking, but do not try to warm your feet before walking.

If you need to re-warm an injured part, it is best to use body temperature either by holding the area with hands or if it is hands or fingers that are affected, put them underneath your arm. If water is used to warm up a body part, keep water at 98.6 to 102 degrees F. And while it might be tempting to sit close to a fire or stove, it can damage the skin even more. Frostbitten skin is likely to be numb and as a result, is more susceptible to further injury.

And, Dr. Bodemer cautions: Do not warm body parts back up if you’re going to be exposed to cold again. That could cause further damage.

“The site of frostbite will likely be painful. Ibuprofen can help limit the inflammation and pain,” said Dr. Bodemer. “But, again, it is important to have any damaged tissue treated by a physician to help minimize risk of infection and prevent further damage.”

If you’re not up to date on your Tetanus vaccination, you’ll need to check with your physician about getting a booster. And Dr. Bodemer offers two final reminders: “Be very careful not to re-expose any affected areas to cold for six to 12 months, including ice packs. And keep in mind once you’ve had frostbite, you are more susceptible to have it again in the future.”