Cold Burn

Cold burn or Frostbite occurs when the skin is in touch with an extremely cold body. Extreme cold can cause damage to the skin and underlying tissues. For example, if there is a prolonged contact of the skin with moderately cold body like snow or very cold bodies like dry ice, liquid helium or liquid nitrogen for a brief period, cold burns or ice burns will occur. Here heat is transferred from the skin and organs to the cold body that is in contact. In other kinds of burns, the body that causes the burn is hotter and heat is transferred to the skin or the organ.

Symptoms of frostbite include pins and needles sensation and then numbness in the area. Initially there may be throbbing or aching. The affected part seems to become insensate. In severe frostbite, when the tissue starts to freeze, the skin at that area may appear white and numb. In areas affected by frost burn, abnormal accumulation of blood takes place. In addition to accumulation of body fluids, a blood clot may form thereby preventing blood circulation around the area resulting in tissue decay. Mottled and violaceous tissue is noticed. Normal functioning of the body is disturbed because of cooling of the internal organs, which will lead to a critical condition called hypothermia. Cooling of the brain or heart is very dangerous.

The accumulated plasma in the blister is intended to prevent further damage and also to help in the healing process. To avoid infection from the blister, it is important that it is not punctured as it would expose the raw skin for further infection. The serous fluid will be reabsorbed by the skin usually after 24 hours if there is no infection.

Severe frostbite may also damage tendons, muscles, nerves and bones. Gangrene is inevitable in the case of very severe frostbite. Frostbite may affect any part of the body.

The most vulnerable parts are hands, feet, nose and ears. Recovery may be significant when the skin and underlying body tissues are injured and it may be permanent if there is injury to the blood vessels. If gangrene follows, the affected part may have to be amputated. When warming up of the affected part begins, the patient will experience intense pain. There will be tingling or burning sensation in the affected area also.

People taking beta-blockers that decrease blood flow to the skin and those who suffer Peripheral Vascular Disease are at risk when exposed to cold for a prolonged period. Any person who is exposed to extreme cold for a long period is susceptible to frostbite. Diabetes, peripheral neuropathy or Raynaud's phenomenon are some conditions that may have increased risk of cold burns. Smoking and windy weather when the rate of heat loss from the skin is more will hinder the healing process. Cold burns at the work place are common. People who work in factories where they may come in contact with metal surfaces that are at extremely cold temperatures are prone to cold burns. When the skin is moist, they may receive almost instantaneous cold burns.

Prevention of freeze burns

Extreme cold, wet clothes, high winds and poor circulation are some of the factors that can contribute to freeze burns. Tight boots or clothing and conditions like cramped positions, some medications, smoking or alcohol can cause frostbite. Wearing appropriate clothing in winter when the temperature goes below normal and will help. Winter clothes like mittens, layered clothing that is wind-proof and water resistant gives good protection.

First Aid for cold burns

It is essential that the ice burn treatment is correctly done as soon as possible.

• If you anticipate prolonged exposure to cold, avoid alcohol or smoking and take sufficient food and rest. Increase physical activity that maintains body temperature and find shelter in a snowstorm as early as possible.
  
  
• Victims should be moved to a warmer place to give shelter from the cold. Constricting jewelry and wet clothes should be removed. If there are symptoms of hypothermia, treat it immediately.
  
  
• Wrap the affected areas using sterile dressings. Dressings should be done after separating affected fingers and toes.
  
  
• In case immediate care is unavailable, you can go for re-warming first aid. This can be done by immersing the affected parts in warm water. Otherwise repeated application of warm clothes to injured ears, cheeks or nose for 20 to 30 minutes helps. Water temperature should be kept between 104 to 108 degrees F. To aid the warming process, the water should be kept circulating. During the warming process, swelling, color changes and severe burning pain may be noticed. The wound will heal when there is a slow heat transfer from water to the affected part.
  
  
• The frost bitten areas should be dressed with dry, sterile dressings. Remembering to keep the fingers or toes separated is important.
  
  
• Thawed areas should not be moved as far as possible.
  
  
• In case of extensive freeze burns, giving warm drinks to the victim helps in replacing lost fluids.
  
  
• Wet clothing must be removed and replaced with warm clothing.
  
  
• Until you reach a warm and safe location, do not go for re-warming process. There is the danger of severe damage because of re-freezing of thawed extremities.
  

Frostnip is the least severe form of cold injury that occurs after the distal extremities are exposed to prolonged period of cold but non-freezing temperatures. Vasoconstriction is felt. Frostnip is a precursor to frostbite and does not involve the same levels of tissue destruction. The affected area appears pale.

Immersion foot is a condition where there is severe tissue injury due to prolonged and persistent exposure to wet conditions, cold or hot. It results in tissue edema and inflammation. This is often seen in homeless persons who are exposed to the elements. The extremities appear swollen and erythematous (skin turning red often manifested in patches). Bad odor is often noticed as also tissue sloughing.

Chilblains

Chilblains or pernio is a common form of cold injury that is often mistaken for frostbite. Frequently seen on the fingers, toes and ears, chilblains are reddish-blue and itchy. They form blisters. Chilblains involve formation of inflammatory skin lesions caused due to repeated intermittent exposure to cold and wet but non-freezing temperatures. Vascular inflammation and tissue bed hypoxia may develop and subsequently lead to permanent tissue damage. Children, elderly persons and those with impaired blood circulation are more prone to developing chilblains when exposed to cold and damp. Symptoms of chilblains are reddish skin and inflammation of toes and fingers. Keep yourself warm, especially during extreme changes in temperature. Some might gain relief on mild massage. Medicines to improve circulation are often prescribed.