When temperatures fall in Colorado, precautions can help in preventing frostbite.

Frostbite is an injury – almost like a burn — that occurs when the skin and tissue freezes after being exposed to extreme cold for too long. Most frostbite injuries occur on the fingers, toes, nose, cheeks, and ears. In most cases, the body part can be rewarmed to avoid long-term injury, but in severe cases, surgery or even amputation may be required.

“The big thing, obviously, is preventing frostbite in the first place,’’ said Dr. Alexis Michopoulos, D.O., a primary care physician for UCHealth Primary Care in Monument. “Stay out of the cold, and if you are in the cold, protect your skin.’’ She said that elderly people, small children, homeless people and those who have peripheral vascular disease or diabetic neuropathy are most at risk for frostbite.

Laura Madsen, RN, burn outreach coordinator for the Burn Center at the University of Colorado Hospital, said people can protect against frostbite by dressing warmly. Several thin layers are better than a single bulky covering, she said. Other tips:

• Mittens provide better protection than gloves
•  Boots and should not be tied tightly
•  If possible, go inside every 30 minutes to warm up
•  Pack your car with a safety kit that includes socks, mitten, hats, coats and blankets
•  Avoid drinking alcohol and smoking
•  Be especially careful when wind accompanies cold weather, as that will reduce the time for frostbite to set in
•  If clothing gets wet, quickly go inside and change to dry clothes

“Frostbite doesn’t only strike people who do extreme sports,” Madsen said. “If your car breaks down, you need protection.”

Dr. Michopoulos and Madsen said some of the signs and symptoms include:

• Coldness, numbing, tingling and itching
• Shivering, which is the earliest sign that the body is losing warmth
• Discoloration of the skin from almost white/yellowish skin to a purplish color. More severe signs are blisters and pain on rewarming.
• Mumbling, stumbling and loss of fine motor skills

“Skin usually doesn’t show up black – the black color occurs when there is death of the tissue, called necrosis,” said Michopoulos, a Colorado Health Medical Group physician. “You can also develop blisters from frostbite.  Another sign is that when you are re-warming yourself, you get significant pain during that process and that is a symptom of frostbite.’’

The No. 1 treatment, she said, is rapid rewarming.

“You are looking at rewarming, which is re-warming with warm water that is between 98 and 102 degrees. It takes about 15 minutes to rewarm, and you have to be careful not to use too hot of water because then you can go in the opposite direction with a different thermal injury and have a burn,’’ Michopoulos said.

A doctor may prescribe an analgesic to help ease the pain of frostbite. In more complicated injuries – if a blister forms or there is a non-healing wound – the person should see a physician immediately.

In some cases of severe frostbite, the Burn Center at UCHealth’s University of Colorado Hospital can treat frostbite with tPA, a medication that breaks tiny blood clots and restores circulation, Madsen said. “If frostbite sets in, we can deliver tPA within eight hours of seeing the patient and starting the warm-up process,” she said.

Despite the recent unseasonably warm weather, the Burn Center has treated three frostbite cases so far this year. Last year, 25 patients came in for treatment, Madsen said.

The best advice to avoid frozen skin? “If at all possible stay inside,” Madsen said. “Limit your time outside and cover up. Any skin that is exposed is at risk for frostbite.”