Frostbite occurs when skin tissue and blood vessels are damaged from exposure to temperatures below 32 degrees Fahrenheit. It most commonly affects the toes, fingers, earlobes, chin, cheeks and nose, body parts which are often left uncovered in cold temperatures. Frostbite can occur gradually or rapidly. The speed with which the process progresses depends upon how cold or windy the temperature conditions are and the duration of exposure to those conditions.

Frostbite has three stages of progression:

Frostnip- In this stage, the individual experiences a pins and needles sensation with the skin turning very white and soft. No blistering occurs. This stage produces no permanent damage and may be reversed by soaking in warm water or breathing warm breath on the affected area.

Superficial Frostbite- In this stage, blistering may occur. The skin feels numb, waxy and frozen. Ice crystals form in the skin cells and the rest of the skin remains flexible.

Deep Frostbite- This is the most serious stage of frostbite. In this stage, blood vessels, muscles, tendons, nerves and bone may be frozen. This stage can lead to permanent damage, blood clots and gangrene, in severe cases. No feeling is experienced in the affected area and there is usually no blistering. Serious infection and loss of limbs frequently occurs after frostbite reaches this stage. However, even with deep frostbite, some frozen limbs may be saved if medical attention is obtained as soon as possible.

Frostbite risk can be reduced by practicing the following:

* Wear several layers of clothing when in extremely cold conditions since the air pockets between the layers will help to retain warmth.

* Limit the use of alcohol and smoking tobacco. Alcohol causes the blood to cool quickly and tobacco inhibits circulation to extremities.

* Avoid going outdoors during extremely cold weather.

* When outside, shield the face and other body parts from the cold wind and temperatures by wearing protective clothing, scarves, earmuffs, gloves, etc.

* Wear waterproof skin moisturizer on exposed areas.

* Do not spend extended periods in extreme temperatures when exhausted, intoxicated, wet or under the influence of certain drugs.

If, after being in extremely cold conditions, any of the following are experienced, seek emergency care.

* skin swelling

* loss of limb function and absence of pain

* drastic skin color changes

* blisters

* slurred speech

* memory loss

If the patient cannot be transported to a hospital immediately, the following re-warming techniques may help until reaching an emergency facility.

--Bring patient indoors as soon as possible.

--Apply warm towels or immerse the area in circulating lukewarm water for twenty minutes. Hot water should not be used and the area should not be rubbed in any way. If blisters are present, leave them intact.

--Do not hold the affected area near fire since the area may be burned due to the reduced feeling in the area.

--Offer the patient warm coffee or tea, if alert, but never alcohol.

--Keep the affected area raised.

After re-warming, a superficial frostbite will redden and become painful as circulation resumes in the area. Blisters are likely to form within 24 hours.

A deep frostbite injury will remain hard, cool to the touch and may turn blue. Blisters may form and the area can turn black. Skin surrounding the affected area may become swollen and remain swollen for over a month. If gangrene develops, amputation may become necessary.

While a frostbite injury is healing, do the following:

---Avoid infection by leaving any blisters intact.

---Watch for signs of infection such as redness, swelling, fever, oozing pus, and red streaks on skin.

---Take all prescribed medications.

---Do not expose the affected area to cold temperatures until cleared to do so by a physician.