Q: We are taking a family ski vacation to Colorado this winter. How do we recognize and protect against frostbite?

A: Frostbite is damage to a body part caused by exposure to temperatures below freezing -— or even above freezing in a strong wind. Injury results from ice crystal formation in tissues and the inflammation that follows. Frostbite can also occur from direct skin contact with very cold objects such as ice packs and metal items. It can develop within minutes or hours of exposure. Areas most commonly affected are fingers, toes, ears, nose, cheeks and chin.


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Risk of frostbite increases with decreasing temperature, increasing wind or humidity, contact with wetness, and time exposed. Populations at risk include soldiers, mountain climbers and other cold-weather enthusiasts, the homeless, and anyone venturing into the cold with inadequate protection. Children and the elderly are particularly susceptible, as are diabetics and those with poor circulation. People who use nicotine, alcohol, recreational drugs and certain blood-vessel-affecting medications, such as beta blockers, are at increased risk. Previous frostbite injury is a liability.

Frostbite initially manifests as cold numb skin that may appear red but then, with further insult, becomes pale, greyish yellow and firm or waxy-feeling. Tingling sensations and pain are common, and there may be trouble moving the affected body part. With rewarming, the skin returns to its normal color but may display blisters and swelling. Later, skin may become black, hard, dry and leathery.

Hypothermia, a life-threatening emergency that may accompany frostbite, requires immediate hospital transport. While frostbite is best treated in a hospital, some measures to be taken in the field are to seek shelter in a warm area, remove wet clothes, drink warm fluids and protect the area of frostbite. If there is no chance of re-freezing, which causes more damage than delayed thawing, rewarm the affected area in a warm water bath or by using body heat. Don't rub the area or apply direct heat such as from a fire, stove, heating pad or hair dryer. Avoid walking on thawed feet. Be aware that the thawing process can be very painful.

Once at a hospital, treatment consists of rewarming (if not previously done), supportive care and wound management. Most frostbite injuries heal with time, but sometimes surgical intervention or amputation is necessary weeks to months after the injury.

Preventing frostbite in the first place is the best strategy. Clothing should be insulating, loose and layered. Avoid constriction of extremities, especially with too-tight boots. Choose mittens over gloves, stay dry and include wind protection. Remember face mask and goggles. Chemical and electrical hand and foot warmers are helpful. Adequate nutrition and hydration are important. Finally, know the weather forecast before setting out, and keep moving.

Sue Smith volunteers with the Grillo Center, which offers free, confidential research to assist in health understanding and decisions. To use this service, contact us at grillocenterhealth.org, 720-854-7293 or 4715 Arapahoe Ave., Boulder. No research or assistance should be interpreted as medical advice. We encourage informed consultation with your health care provider.