Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
If you come to the emergency department and still have any white areas of frostbite, the doctor will begin rapid rewarming in water that is slightly above body temperature. The frozen parts are thawed until they are pink, which shows that the circulation has returned.
If the warmed area is only a little red, you may be allowed to go home with instructions about how to protect the injured area. If you have only clear blisters that go to the ends of the fingers and toes along with swelling and some pain, you may also be allowed to return home with instructions. If you have dark blisters, no swelling, or no circulation in the warmed area, you will be hospitalized.
In either case, you may be asked to take aspirin or ibuprofen (Advil), which may protect against further injury to the area from substances that are released from damaged cells. You may also be given other medications to help the circulation of blood and to assure good nutrition.
If you are hospitalized, the injured areas will be wrapped most of the time and elevated. Twice a day they will be unwrapped and placed in a whirlpool to remove bacteria and dead cells that build up on the surface of the skin. If frostbite is severe, it may be necessary to remove some of the dead areas by amputation.
Immersion injury is treated like frostbite, although initial thawing in warm water is not necessary.
Frostnip is treated by rewarming the area and protecting it from further cold exposure.
Treatment of pernio is the same as for frostbite: rewarming the area, washing, drying, sterile dressings, and elevation. Pain medicine may be needed.
Raynaud's phenomenon is treated by avoiding cold exposure and sometimes by medications that relax the blood vessels to avoid the narrowing that occurs in response to cold.
Cryoglobulins are treated by avoiding cold exposure, not standing for prolonged periods and, in severe cases, plasmapheresis (removal of proteins from the blood).
Cold urticaria may respond if you avoid cold. Sometimes medications may be necessary.