Clinical Features

Frostbite can occur on any skin surface but is generally limited to the nose, ears, face, hands, and feet. Frostbite has been reported in the penis and scrotum of joggers and in burn patients after prolonged treatment with ice. Also, a freezing keratitis of the cornea has been reported in snowmobilers and skiers who did not wear protective goggles.

Frostnip is on a continuum with frostbite and is a superficial freeze injury characterized by lack of extracellular ice crystal formation and absence of progressive tissue loss. The involved extremity appears pale from intense vasoconstriction and is associated with some discomfort. Symptoms resolve on rewarming, and tissue loss does not occur.

There has been much debate over the proper classification of the severity of frostbite.10 One may classify frostbite into degrees of injury or into superficial and deep groups (Table...185z2). First- and second-degree injuries are classified as superficial, whereas third- and fourth-degree injuries are classified as deep. The initial clinical appearance is often deceiving, especially if some warming has not occurred. Most patients present after some warming has occurred and are in phase II of the injury. Frostbite classification is based on the time of presentation.

TABLE 185-2 Classification of Cold Injury According to Severity

First-degree injury is characterized by partial skin freezing, erythema, mild edema, lack of blisters, and occasional skin desquamation several days later. The patient may complain of transient stinging and burning, followed by throbbing. Prognosis is excellent.

Second-degree injury is characterized by full-thickness skin freezing, formation of substantial edema over 3 to 4 h, erythema, and formation of clear blisters rich in thromboxane and prostaglandins. The blisters form within 6 to 24 h, extend to the end of the digit, and usually desquamate and form black, hard eschars over several days. The patient complains of numbness, followed later by aching and throbbing. Prognosis is good.

Third-degree injury is characterized by damage that extends into the subdermal plexus. Hemorrhagic blisters form and are associated with skin necrosis and a blue-gray discoloration of the skin. The patient may complain that the involved extremity feels like a "block of wood," followed later by burning, throbbing, and shooting pains. Prognosis is often poor.

Fourth-degree injury is characterized by extension into subcutaneous tissues, muscle, bone, and tendon. There is little edema. The skin is mottled, with nonblanching cyanosis, and eventually forms a deep, dry, black, mummified eschar. Vesicles often present late, if at all, and may be small, bloody blebs that do not extend to the digit tips. The patient may complain of a deep, aching joint pain. Prognosis is extremely poor. -I0.!!,!2 ! and 14

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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