Cold injuries

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Background

  • Frostbite occurs only when ambient temperatures are well below freezing
  • Nonfreezing cold injuries occur due to exposure to wet conditions when temper >freezing

Nonfreezing Cold Injuries

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