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- A severe localized injury due to cold exposure, causing tissue to freeze, resulting in direct cellular injury and progressive dermal ischemia (most commonly of exposed hands, feet, face, and ears)
- Systems affected: integumentary, vascular, muscular, skeletal, nervous
- Synonym: dermatitis congelationis
- Predominantly adults but can affect all ages
- Predominant sex: male = female
Etiology and Pathophysiology
- Prolonged exposure to cold
- Refreezing thawed extremities
- Ice crystals form intracellularly and extracellularly.
- Vasoconstriction reduces blood flow and microvascular endothelial injury leads to ischemia.
- Cellular dehydration leads to abnormal electrolyte concentrations and cell death.
- In severe cases, tissue injury extends to muscle and bone leading to necrosis and mummification.
- Rewarming injured endothelium results in edema and bullae.
- Inflammatory mediators such as prostaglandins and thromboxane A2 induce vasoconstriction and platelet aggregation, worsening ischemia.
- Prolonged exposure to below freezing temperatures, especially combined with wind and/or water exposure
- High-altitude activities, such as mountaineering
- Military operations in cold environments
- Constricting or wet clothing with inadequate insulation
- Altered mental status due to alcohol, drugs, or psychiatric illness
- Previous cold-related injury
- Dehydration and/or malnutrition
- Raynaud phenomenon
- Peripheral vascular disease
- Dress in layers with appropriate cold weather gear and avoid clothing that is too constricting.
- Cover exposed areas and extremities appropriately.
- Stay dry; avoid alcohol and minimize wind exposure.
- Ensure adequate hydration and caloric intake.
- Use supplemental oxygen at very high altitudes (>7,500 meters).
- Exercise can protect against frostbite by increasing core and peripheral temperatures.
- Appropriate use of chemical or electric hand and foot warmers can help maintain peripheral warmth.
Commonly Associated Conditions
- Alcohol or drug abuse