Topical Nifedipine Administration for Secondary Prevention in Frostbitten Patients

Frostbite is a cold-related injury with a growing incidence among healthy subjects. Sequelae after frostbite are frequent and vary among individuals. Here, we studied the thermal response in the digits of hands and feet of five subjects who had recovered from previous frostbite, except for their lasting sequelae. We considered three different conditions: digits unaffected by frostbite nor sequelae (healthy), those affected but which did not suffer amputation (frostbitten without amputation), and the remainder/stumps of digits that underwent partial amputation (frostbitten with amputation). Three consecutive immersions in cold water (8°C; 3 min) interspersed by 1 minute of thermal recovery were performed. After 30 min, a topical 10% nifedipine preparation was applied to hands and feet, and the same cold exposure protocol to evaluate its effect was followed. In basal condition and immediately after each immersion, the temperature of individual digits was assessed using thermography. We observed different thermal responses among the different digits of hands and feet, even without the nifedipine treatment. Nifedipine had a cooling effect on healthy and post-amputated tissue without thermal stress. In cold conditions, topic nifedipine application improved the cold response in healthy fingers but had a negative effect on those from which parts had been amputated. The topical nifedipine had detrimental effects on toes in all conditions. Topical nifedipine can help to the preservation of healthy fingers exposed to cold, with adequate thermal insulation; but it is necessary to remark its potentially harmful effects on previously frostbitten tissue. Because of the differences observed on individual regional response to cold, thermography can be a useful tool in the frostbite prevention for subjects habitually exposed to cold environment.