skin turns red and BURNS or hurts, sometimes
severely.
Treatment Options and OutlookPrompt treatment is essential to save the affected
tissue and body parts. When possible, a doctor
should evaluate the situation and implement
warming procedures for maximum recovery. To
protect body parts until the person receives med-
ical treatment, wrap them in sterile bandages (sep-
arating the fingers and toes, if affected). When
immediate medical attention is not possible,
warming the frostbitten areas should only be
undertaken when they cannot refreeze.
Refreezing does more damage than
allowing the area to remain frozen. Do
not thaw frostbite unless the area can
remain warm.To warm frostbite, place the affected parts
under gently running warm water for 20 to 30
minutes. The water temperature should be 8º to
10ºF above normal body temperature or about
108ºF, which feels warm but not hot to someone
whose skin temperature is normal. For frostbitten
ears, cheeks, or nose, apply cloths dipped in warm
water. Do not use dry heat, as it will further dam-
age the skin and tissues. Severe frostbite is likely
better left for emergency care providers to treat
because tissue damage is likely to be extensive.
The thawing process can be extremely painful,
and may require PAINrelief medications. Superfi-
cial frostbite (first and second degree) usually
heals with few or no residual consequences. Frost-
bite that extends deeper than the layers of the
skin (third and fourth degree) can destroy MUSCLE,
connective tissue, joints, and BONE, and may
necessitate AMPUTATIONor surgery to clean away
necrotic tissue. A full damage assessment may not
be possible for six to eight weeks, as it may take
that long for tissue to demonstrate whether it will
recover or die.
Risk Factors and Preventive Measures
People who spend extended time outdoors in cold
weather, such as for employment or recreation, risk
frostbite when exposure time extends beyond what
clothing can protect. Wetness increases the risk.
People who are very young or very old or who have
DIABETES, PERIPHERAL VASCULAR DISEASE (PVD),
RAYNAUD’S SYNDROME, untreated or undertreated
HYPOTHYROIDISM, OR MALNUTRITIONmay develop frost-
bite far more rapidly and severely. Preventive
measures include protective clothing appropriate
for the weather conditions and limiting exposure
when temperatures are extremely cold.
See also HYPOTHERMIA.furuncle An infected HAIR follicle, commonly
called a boil. A furuncle develops when BACTERIA
normally present on the surface of the SKIN(typi-
cally staphylococcus) causes a collection of dead
cells and fluid (pus) to block the follicle. The
blocked follicle becomes reddened, inflamed,
enlarged, and usually quite painful. Furuncles are
most likely to develop in the underarm area,
groin, hairline at the back of the neck, and, in
men, the beard area of the face.
Most furuncles improve with frequent applica-
tions of moist heat, which helps open the follicle
and drain the collected pus. A typical furuncle
heals on its own in 7 to 10 days, though a large
furuncle may take longer. A furuncle that does
not improve within 10 days warrants a doctor’s
evaluation and may require lancing (a small inci-
sion to drain the INFECTION) or ANTIBIOTIC MEDICA-
TIONS. People who have DIABETES or who are
IMMUNOCOMPROMISEDare more likely to develop
furuncles.
Furuncles tend to recur. Preventive measures
include reducing irritation from clothing and regu-
lar cleansing with an antibacterial soap. Prompt
treatment at the earliest indication of a furuncle
can minimize or head off the infection’s develop-
ment. A large furuncle may leave a SCARafter it
heals, though most furuncles heal without scarring.
See also CARBUNCLE; FOLLICULITIS; INGROWN HAIR;
PSEUDOFOLLICULITIS BARBAE.goose bumps A bumpy texture to the SKIN, also
called gooseflesh, that results when the erector
muscles in the HAIRfollicles contract, causing the
hair to “stand up.” Goose bumps occur when a
person becomes chilled or fearful, a vestigial
response no longer physiologically useful in
humans. The physiologic mechanism that causes
goose bumps, called the pilomotor REFLEXor pilo-160 The Integumentary System