Symptoms
Frostbites are inflamed, superficial, painful, itchy to burning, swollen, reddened to blue-purple skin lesions (patches, papules, plaques). They occur recurrently on both sides, especially dorsally on the fingers and toes. Other exposed areas such as ears, face, nose and thighs may also be affected. Frostbite is most commonly seen in winter and spring. Possible complications include scaling, atrophy, scarring, blisters, ulceration, necrosis, and superinfection.
Causes
Frostbite is a reaction to cold temperatures and a humid climate. It is not frostbite, in which tissues freeze (see there). It is thought to be an excess vasoconstriction as a result of exposure to cold, which leads to an undersupply of oxygen to the tissue and an inflammatory response. The humidity additionally intensifies the cooling. A distinction is made between acute development a few hours after exposure and chronic development after repeated exposure to cold. Frostbite can occur secondary to disease, for example, as a result of lupus erythematosus.
Risk factors
Various studies have identified low BMI, female sex, individual disposition, poor circulation, occupation, horseback riding, motorcycle riding, constipation, and heredity as possible risk factors, among others.
Nonpharmacologic treatment
The condition is usually self-limiting within approximately 1-6 weeks if the trigger is avoided. It is important to keep the affected area warm and avoid cold if possible. Warmth is a reliable means of prevention and treatment. Gloves, thick socks, heat socks, sturdy shoes, hand warmers, and heat pads, among others, can be used for this purpose. Smoking should be stopped due to its negative influence on the vessels.
Drug treatment
Calcium channel blockers:
- For drug treatment, the literature mainly mentions the oral vasodilator calcium channel blocker nifedipine (Adalat, generics). Nifedipine appears to accelerate healing and reduce symptoms. However, only small clinical trials have been conducted and its use is not officially approved by the authorities (off-label). In the study by Dowd et al (1986), 20 mg of sustained-release nifedipine was administered 3 times daily. Possible adverse effects include low blood pressure, headache, skin flushing, and oedema. Appropriate precautions should be observed. Diltiazem appears to be less effective
Wound care:
- Depending on the severity, appropriate wound treatment is necessary. Skin care products protect and care for the pre-damaged skin.
Other medicines:
- Vitamin D appears to be ineffective. The results on the use of topical glucocorticoids are contradictory. For secondary frostbite, treat the underlying disease.
