Winter weather brings with it a flurry of outdoor fun, from snowball fights to skiing and sledding. However, when the temperatures plummet, being outdoors for even just a few minutes without proper protection from the elements can put you at risk for developing frostbite. While frostbite is typically a treatable condition, in severe cases, it may result in problems that require an amputation.

Frostbite means the skin—and sometimes the tissues underneath the skin—freezes. That’s because 64 percent of skin consists of water. Just like water turns to ice in freezing temperatures, ice crystals can form inside the cells of skin exposed to cold temperatures for extended periods of time if not properly covered. 

Circulation issues can increase the risk of frostbite, which usually occurs in peripheral areas of the body located farther from the heart. (To help preserve warmth in the body’s core, where the major organs are located, the vascular system will decrease blood flow [vasoconstriction] to the extremities in the presence of extreme cold.) 

Infants and young children are particularly at risk because they can’t always communicate their symptoms and lose heat from the skin more readily,” says Sara Perkins, MD, a Yale Medicine dermatologist.

People of all ages should be on alert for frostbite, though. “Temperature changes, moisture and underlying health conditions can all influence the risk for developing frostbite,” she adds.

At Yale Medicine, we care for patients with a variety of skin conditions and provide advice below on how to prevent and recognize frostbite.

• Redness
• Stinging or burning sensation
• Numbness
• Throbbing
• Aching
• Prickly, pins-and-needles feeling
• Pale, yellow or bluish areas on the skin
• Blackened areas of skin (gangrene)
• Thick, hardened skin

Prolonged periods spent outdoors in very cold temperatures, as well as wet and/or windy conditions, can lead to frostbite. Below are other things you should be aware of that decrease blood flow, which can increase your risk:

• Health conditions that cause poor circulation such as diabetes, Raynaud’s phenomenon, peripheral arterial disease, and peripheral neuropathy
• Tight-fitting clothes (boots, socks, gloves, long johns)
• Certain medications, including beta blockers

If you recognize symptoms of frostbite, immediately go indoors where it is warm. Try to gradually warm up and bring back feeling to the skin. (But avoid rubbing frostbitten skin—the friction can further damage skin cells.) 

Remove any jewelry or constrictive clothing. And don’t warm up in front of a fire or heater. Because frostbitten skin is numb, you may not realize how close you are to the heating source, and may burn your skin.

A method dermatologists recommend is to apply a warm washcloth to the affected area to bring gradual warming. Follow this by immersing the affected area in warm (never hot or cold) water or simply wrapping yourself up in blankets. You can use your own body heat to warm your child’s skin as well. 

If you notice your skin developing a gray, white, yellow, blue or black discoloration, or if after trying to rewarm the area you do not feel sensation returning to numbed skin, seek medical attention immediately at a hospital emergency room. In addition to being assessed for frostbite, you’ll be checked for hypothermia. This is a serious medical condition in which the body temperature is so low that brain function is affected, causing confusion, low energy, drowsiness, memory loss, altered speech, shivering and exhaustion.

Frostbite can affect not only deeper layers of skin, but also muscles, bones and blood vessels. If the blood vessels are damaged, they may never recover. Without proper blood flow to the affected area, gangrene can develop, which occasionally can only be treated by amputating the affected limb. 

To prevent frostbite, preparation is key before heading outdoors. The American Academy of Dermatology shares the following tips:   

• Dress in loose, light, comfortable layers: Wearing loose, light layers helps trap warm air. Your first layer should be made of a synthetic material, which can wick moisture away from your body. The next layer should be insulating—wool and fleece hold in more heat than cotton fabrics. Choose a windproof and waterproof (or water resistant) outer layer.
• Cover up: Be prepared with proper winter wear. What you believe to be a brief time outdoors could easily turn into hours in frigid temperatures due to unforeseen events, like a car accident (or breakdown) or locking yourself out of the house.
• Protect your feet: If you take part in cold-weather activities, double up your socks to protect feet and toes. Wear a moisture-wicking pair of socks to keep the feet dry, then add a wool or wool-blended sock for warmth. Be sure your boots are insulated and high enough to keep snow out.
• Hats: Hats protect your head and ears, and scarves and face masks can help prevent frostbite on the ears, nose, cheeks and chin.
• Avoid metal: Since metal conducts cold, take care not to touch metal surfaces with bare skin.
• Keep skin dry. Seal out snow, ice and rain with waterproof or water-resistant outerwear, and  change out of clothing that becomes damp from the elements or perspiration. 
• Stay hydrated: Drink a glass of water before you head outside, and sip water or a sports drink before and throughout outdoor workouts—dehydration slows blood circulation. 

“A thorough understanding of the scenario, careful physical examination and prompt management are key, but there’s also an important opportunity for education about the condition, assessment of underlying risk factors and review of tools for prevention,” Dr. Perkins says.