For fans of winter sports, there’s nothing more exhilarating than crisp, cold air and a blanket of snow for skiing, snowmobiling, sledding, or just plain horsing around. But the nip in the air can have an unforgiving bite if you’re not dressed properly to ward off the elements. Indeed, you may not realize how cold it actually is outside-until frostbite develops.

Frostbite occurs when the fluids in the skin tissues begin to freeze, or crystallize, restricting blood flow to the affected area. Most cases of frostbite occur on the hands, feet, toes, nose, and ears. The reason is that as the body temperature drops in reaction to prolonged exposure to cold, the heart attempts to protect vital organs by increasing circulation to the torso at the expense of the extremities.

While it is wise to have any suspected case of frostbite checked out by a doctor, you need to take steps right away to rewarm and protect the affected areas. The tips that follow can help you care for frostbitten skin and help you protect yourself from Jack Frost’s bite in the future.

Treating Frozen Skin

Here what to do-and what not to do-if you suspect that you are developing frostbite:

Watch for the warning signs. The sooner you notice the symptoms of frostbite, and the faster you take measures to rewarm the areas, the better the outlook for recovery. The skin may first start to tingle, as ice crystals begin forming in the tissues. Then, pain develops, accompanied by redness, burning, itching, and swelling. If exposure to cold continues, numbness sets in, the pain decreases, and the skin becomes whiter and waxy looking. At this stage, immediate action is necessary to prevent gangrene, or death of skin tissue.

Warm up the right way. If you become frostbitten, don’t run to the nearest radiator, hot stove, or roaring fire. “The numb extremity may not sense the intense heat, and you may burn the delicate, damaged tissues,” says Roger Thurmond, M.D., a dermatologist in private practice in Fairbanks , Alaska . For the same reason, do not use a heat lamp, hot-water bottle, or heating pad to warm up. Submerging the affected extremity in a sink or basin full of warm water (l04 degrees Fahrenheit to no more than 110 degrees Fahrenheit) is the safest way to treat the frostbite. Once your fingers or toes are warmed up, very gently wiggle them to increase the circulation to the area. For frostbitten ears or a frostbitten nose, moving to “a heated room should be enough to warm them up,” says Thurmond. If not, gently apply warm compresses to the affected area; do not rub the delicate tissue.

Warm up rapidly. Experts have found that rewarming the frostbitten area as quickly as possible “promotes faster healing, reduces tissue loss, and helps prevent complications, such as gangrene-and even loss of a limb,” says Jerome Z. Litt, M.D., an assistant clinical professor of dermatology at Case Western Reserve University School of Medicine in Cleveland. Rapid rewarming may initially cause more pain, redness, and swelling, and result in bigger blisters. The payoff: Mild to moderate frostbite should heal in a week or two.

Don’t thaw and then refreeze. Thawing and then refreezing a frostbitten area can cause even more damage, so if you cannot keep the injured area warm, it may be best to postpone rewarming until you are safely out of the cold.

Stay as warm and dry as possible. Even if your clothes are dry, they may be cold enough to keep you from warming up. Clothing that is wet depletes heat even more and should be removed. However, if you are out in the cold with no chance of getting to a warm place quickly, your better bet may be to just add layers of warmth to what you already have on.

Huddle with a buddy. A friend’s body heat will help warm you up. Drink plenty of fluids. Sipping warm or tepid fluids may make you feel better and, more importantly, will keep you from getting dehydrated, which can make your frostbite worse. (Becoming dehydrated also makes you more susceptible to frostbite in the first place.) Do not, however, eat snow. And stay away from alcoholic beverages, which actually encourage fluid loss.

Elevate the affected area. This minimizes edema, or swelling, of the affected area. It’s important to do this because swelling can interfere with proper circulation, which is necessary for proper healing.

Don’t use snow. “That’s just old folklore,” says Litt. “Rubbing frostbite with snow or ice will break down the skin cells and possibly lead to gangrene.”

Don’t rub or massage the frostbitten area. This will also cause further damage to the skin, says Litt.

Keep off your feet. If possible, don’t walk on your ¬≠ frostbitten toes. As with any frostbitten area, they need to be immobilized for proper healing.

Keep your toes or fingers apart. Use sterile gauze to separate the affected digits. “This helps to immobilize the delicate tissues, which may be apt to stick together as they blister and heal,” says Thurmond.

Try this solution for blisters. During the thawing process, blisters may develop and persist for weeks. If this occurs, mix Burow’s solution (available without a prescription in packets and tablets at pharmacies) and warm. water (between 104 degrees and 110 degrees Fahrenheit) according to the package directions, and apply the solution to the blisters with wet compresses for 15 to 20 minutes every two to three hours until the blisters have begun to dry up, says Litt.

Preventing frostbite

With a little advance planning and preparation, you can protect your skin and keep frostbite from developing in the first place. Here’s how:

Wear fabrics specially made for cold or wet weather. “The ideal outerwear traps a lot of air between you and the elements,” says Litt. “Loosely woven bulky wool and acrylics are good choices,” he says. Litt and other experts also recommend clothing made with Thinsulate, Hollofil, Gore- Tex, or other “high-tech” materials, which can help keep you both warm and dry.

Keep your head covered. You can lose a significant amount of body heat from the neck up, says Litt. This is due to the disproportionately large amount of blood circulating there. “That’s why it’s true when they say that if your feet are cold, you should put a hat on,” says Philip Gormley, WE.M.T., operations director of Wilderness Medical Associates in Bryant Pond, Maine. He suggests wearing a wool hat and scarf and earmuffs in order to help keep your whole body warm.

Layer, layer, layer. Gormley suggests polypropy¬≠lene liners on the hands and feet, followed by down mittens and wool socks, respectively. Jonti Fox, former associate program director of the Colorado Outward Bound School in Denver, recommends wearing a lightweight shirt, then a heavier-weight one over it, covered by a chinchilla jacket, and, finally, a water-resistant windbreaker. Boots with separate, removable inner liners of felt or Gore-Tex are also recommended. Experts agree that clothing and footwear should not be tight. Too-tight cuffs and boots, for instance, can decrease circulation to the extremities. “The best-fitting boots will allow you just enough room to move your toes, even if you have an extra pair of socks on,” says Fox.

Put sandwich bags in your boots. The bags act as a barrier to keep your feet dry if your boots should get wet, says Gormley.

Give your hands a spin. If your fingers start to tingle, whirl your hands round and round at the wrist. “The centrifugal force you create should help get more blood circulating to the chilled fingers,” says Thurmond.

Eat right and get plenty of rest. Poor nutrition and fatigue can exacerbate the problem by lowering your resistance and hindering circulation, making ill more prone to frostbite. For strenuous outdoor activities, Fox recommends foods with complex carbohydrates and fats, such as pasta and nuts, for long-term energy, and simple sugars, such candy, for quick energy boosts.

Avoid alcohol. Alcohol can impair your awareness how cold you are. Alcohol is also a diuretic, which can contribute to dehydration.

Do not smoke. Some people light up when they’re cold thinking it’s going to make them warmer. The truth is that smoking constricts the blood vessels and decreases circulation to the extremities, which is why smokers are at higher risk for frostbite.

Be aware that medicines playa role. “Prescription drugs, such as tranquilizers, and over-the-counter medications, such as sleeping aids and antihistamines, can also impair your judgment as to how cold you’ve become,” says Litt. There are many drugs that can act in this way; check the label or ask your pharmacist to find out if any medication you are taking could have this effect.

Don’t touch metal. Coming in contact with metal in the cold can cause instantaneous frostbite, causing you to stick right to it. If this should happen, pour warm water (again, at about 104 degrees to 110 degrees Fahrenheit) over the injury site to loosen it.

If stranded on a wintry day, stay with your car. This is your best bet, unless, of course, you are in immediate danger or you can seek help very nearby. “Leaving the car to brave the elements will deplete your energy and dehydrate you,” says Thurmond. This predisposes you to frostbite and hypothermia . You also run the risk of getting lost. Furthermore, rescue crews can more easily spot a vehicle than a person in distress. So stay put.

Always keep emergency supplies in the car. In addition to a first-aid kit and tools for repairing minor problems such as flat tires, these supplies should include protection for you. Stuff a box with a blanket or two, an extra pair of gloves, a hat, boots, earmuffs, a sweater for everyone who will be traveling, candles, and matches. Hot packs used by hunters may also come in handy.

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