Hitting the ski slopes, roasting marshmallows, and going for a wintery stroll. There are many highlights of winter, but the season can also bring plunging temperatures and outdoor environments that can lead to frostnip and frostbite. 

Summit Health urgent care and internal medicine physician Paul Girardi, DO tells us how to prevent and treat these dangerous conditions that affect the skin, our body’s largest organ — and how to know when it’s time to seek medical help. If you have any symptoms of frostnip or frostbite walk into your neighborhood CityMD urgent care for a timely evaluation and diagnosis or make an appointment with a primary care physician immediately.

What is frostnip?

Frostnip is the stage that occurs before frostbite, when your skin is exposed to very cold temperatures and becomes numb, tingly, or pale. There's no permanent damage with frostnip, and those tingly feelings will eventually resolve as your skin warms back up. It can be hard to distinguish frostnip from early stages of frostbite as both can result in a loss of sensation in your skin.

What is frostbite?

Frostbite occurs when areas of your body are exposed to subfreezing temperatures for prolonged periods of time. As frostnip progresses into frostbite the skin may become hard, change colors, and have a waxy-looking appearance. However, unlike frostnip, frostbite can lead to blistering and permanent tissue damage.

Milder cases of frostbite result in swelling, pain, and redness of the skin when rewarmed.  In more severe instances you may see a complete loss of the affected tissue all the way down to the muscles and bone. In these cases, amputation may be necessary.

How can you prevent frostnip from progressing to frostbite?

The first step you should take is to find a safe place where you can warm up indoors. Body heat and warm blankets can be helpful, as well as submerging affected areas in warm water. Because you'll have diminished sensation in your skin, it is important to avoid hot water as you can easily burn yourself and cause more damage.

Before going back outdoors, make sure your clothing and skin are dry. Going forward, put on enough layers to protect any vulnerable areas and minimize exposure of your bare skin to winter conditions.

When should you see a doctor?

If your skin appears blistered or damaged after experiencing frostbite, you should see a doctor. It can be difficult to ascertain the severity of a case of frostbite, but if you have any blisters or discoloration where your skin appears waxy and gray, blue, or white, you should immediately go to an emergency department for treatment. Moderate to severe frostbite can be safely treated at a hospital, where they have access to rewarming techniques and devices. 

How can a primary care physician help?

Primary care physicians can help manage cases of mild frostbite, as well as the healing process after moderate to severe cases of frostbite have been initially treated at a hospital. Depending on the severity of the damage, the areas of dead tissue will eventually require wound care, infection prevention, and possibly even a referral to a surgeon.

How to treat frostbite?

Frostbite is first and foremost treated with rewarming. It’s essential that the rewarming process begins only in an area where the risk of refreezing or re-exposure to subfreezing temperatures is unlikely. This is because the cycle of freezing-rewarming-freezing can cause more damage than the initial frostbite.

Another treatment involves the use of clot-busting medications, as severe frostbite can result in significant damage to blood vessels and cause blood to clot. Prompt administration of blood thinners can return blood flow to the areas of severe frostbite that have been cut off due to the freezing damage.

Frostbite prevention tips

If you or your loved ones are going out in the cold, it’s more than important ever to stay vigilant and keep warm.

• Limit exposed areas of skin. Wind exposure can increase the risk of frostbite, with the face, ears, hands, and feet most affected — so don't forget those hats, scarves, or neck gaiters, as well as mittens, earmuffs, and thick socks with sturdy, water-resistant boots. The more of your gear that is waterproof or water resistant, the better.
• Always bundle up your kids. Remember to frequently check on your children to make sure they are still wearing the clothes you sent them outside in.
• Stay dry. This is as important as staying warm. Keeping yourself dry will prevent frostbite along with other serious cold weather injuries like hypothermia or trench foot.
• Wear proper gear. For those who enjoy being active outside in the winter, most sporting goods companies have a line of cold weather gear that will allow you to layer up without getting weighed down or bulked up. In any case, be sure to cover as much of your skin as possible.
• Stay away from ointments. Protective ointments for the face, ears, and neck can accelerate heat loss and result in quicker onset frostbite. Those ointments are usually only protective against windburn.
• Drink responsibly. Using alcohol can increase your risk of developing frostbite. Physiologically, it causes heat loss, prevents your body from generating heat, and decreases awareness of the cold conditions around you, all of which can result in frostbite.
• Protect your eyes. Wear goggles in outdoor winter sports and sunglasses when out for a winter stroll to prevent damage from the cold, wind, and even sun.
• Know your limits and risk factors. Persons with diabetes, individuals who smoke, or those with peripheral vascular disease or significant smoking history are also at higher risk for frostbite. This is due to poor circulation and possibly neuropathy, which could prevent them from recognizing damaging cold temperatures in time.