Description

• A localized complication of exposure to cold, causing tissue to freeze, resulting in diminished blood flow to the affected part (especially hands, face, or feet)
• System(s) affected: Endocrine/Metabolic; Skin/Exocrine
• Synonym(s): Dermatitis congelationis; Frostnip; Environmental injuries

Epidemiology

• Predominant age: All ages
• Predominant sex: Male = Female

Risk Factors

• Previous cold-related injury
• Decreased caloric intake (<1,500 calories/d)
• Dehydration or hypovolemia
• Impaired cerebral function
• Under the effects of alcohol or drug abuse
• Underlying psychiatric disturbance
• Ambient temperature ≤–17.8°C (0°F)
• Smoker
• Elderly
• Lean body mass
• Low level of fitness
• Lack of proper clothing or shelter
• Raynaud phenomenon
• Peripheral vascular disease
• Diabetes mellitus
• Constriction from excessively tight clothing (including too many layers of socks)
• Vehicular failure leading to prolonged cold exposure

General Prevention

• Dress in layers with appropriate cold-weather gear.
• Avoid clothing (including footwear) that is too constricting.
• Cover exposed areas and extremities appropriately.
• Prepare properly for trips to cold climates.
• Minimize wind exposure.
• Stay dry.
• Avoid alcohol.
• Ensure adequate hydration and caloric intake.
• Supplemental oxygen at very high altitudes (>7,500 m).

Pathophysiology

• Ice crystals form intracellularly.
• Vasoconstriction reduces blood flow and microclotting leads to ischemia.
• Dehydration, enzymatic destruction, and ultimately cell death occur.
• In severe cases, deep-tissue freezing may occur with damage to underlying blood vessels, muscles, and nerve tissue.

Etiology

• Prolonged exposure to cold
• Refreezing thawed extremities

Commonly Associated Conditions

Alcohol and/or drug abuse