Cold injuries
Background
- Frostbite occurs only when ambient temperatures are well below freezing
- Nonfreezing cold injuries occur due to exposure to wet conditions when temper >freezing
Trench Foot
Background
- Develops slowly over hours-days when foot is exposed to cold/wet conditions
- Reversible injury may progress to irreversible injury
Clinical Features
- Tingling/numbness is initial symptom
- Foot appears pale, mottled, anesthetic, pulseless, and immobile
- Initially does not change after rewarming
- Hyperemic phase begins w/in hr after rewarming
- Assoc w/ severe burning pain and reappearance of proximal sensation
- As perfusion returns to foot over 2-3d edema and possibly bullae may form
- Anesthesia persists for weeks and may be permanent; gangrene may occur
Treatment
- Keep feet clean, warm, dryly bandaged, elevated
- Monitor for signs of infection
Pernio (Chilblains)
Background
- Mild but uncomfortable inflammatory lesions of skin
- Caused by long-term intermittent exposure to damp, nonfreezing ambient temperatures
- Primarily a disease of women and children
Clinical Features
- Hands, ears, lower legs, feet most commonly affected
- Symptoms
- Tingling, numbness, pruritus, burning paresthesias
- Cutaneous manifestations appear up to 12hr after acute exposure:
- Localized edema, erythema, cyanosis, plaques, nodules
- May progress in rare cases to ulcerations, vesicles, and bullae
- Rewarming may result in formation of tender blue nodules which may persist for days
Treatment
- Affected skin should be rewarmed, gently bandaged, and elevated
- Nifedipine 20mg PO TID may be helpful as both prophylactic and therapeutic tx
- Topical corticosteroids and oral steroid burst have been shown to be useful
Cold Panniculitis
- Prolonged exposure to temp >freezing leads to mild necrosis of subcutaneous fat tissue
- Seen in children (popsicles) and women involved in equestrian activities
- Resolution may result in adipose fibrosis w/ cosmetic defects
- There is no treatment
Cold Urticaria
- Hypersensitivity to cold air or water which may lead to fatal anaphylaxis
- Treat similarly to urticarial lesions from other causes (i.e. antihistamines)
- Avoidance of cold is recommended
Source
Tintinalli