Frostbite

Definition

Frostbite is damage to skin and tissues from being exposed to below-freezing temperatures for a long time. It is most common on the fingers, toes, ears, nose, chin, and cheeks.

This problem needs to be treated right away.

Frostbitten Skin

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Causes

This problem is caused by exposure to below-freezing temperatures. It causes ice crystals to form within body tissues. This blocks blood flow and oxygen. It leads to tissue damage or death. Some damage may also happen during warming.

Risk Factors

This problem is more common in people who are 30 to 49 years of age.

Other things that may raise the risk are:

  • Prolonged exposure to below-freezing temperatures without enough protection
  • Poor use or failure of cold weather gear
  • Spending time in high altitudes
  • Homelessness or poor shelter
  • Trauma
  • Taking medicines that cause blood vessels to become constricted
  • History of prior cold weather injury
  • Having health problems that are linked to poor blood flow, such as:
  • Behavioral factors, such as:

Symptoms

Early stages may cause:

  • Weakness or clumsiness, such as with the hands or feet
  • Numbness, stinging, burning, or tingling feelings
  • White skin blended with or next to healthy-looking skin
  • Cold or firm skin
  • Pain
  • Inflammation

Later stages may cause:

  • Waxy looking skin
  • A change in skin color that may range from white to blue
  • Blisters that may be filled with clear or bloody fluid

Diagnosis

The doctor will ask about your symptoms and health history. You will ask about any recent exposure to cold. A physical exam will be done. It will focus on the damaged areas. This is enough to make the diagnosis.

Treatment

Treatment is needed right away. The goals will be to rewarm the body and prevent further damage.

Rapid rewarming in a warm (98.6 °F to 102.2 °F / 37 °C to 39 °C) water bath is the main treatment. Slow rewarming may cause more damage.

Other choices are:

  • Supportive care, such as padding, splinting, and resting the area
  • Skin care to promote healing, such as aloe vera gel or ointments
  • Medicines, such as:
    • Over the counter or prescription pain relievers
    • Antibiotics to treat infection
    • Thrombolytics to improve blood flow
    • Vasodilators to open blood vessels
    • A tetanus booster shot

People who are not helped by these methods may need surgery or amputation to remove dead or damaged tissue.

Prevention

The risk of this problem may be lowered by:

  • Avoiding exposure to temperatures below 5 °F/-15 °C
  • Protecting the skin from moisture, wind, and cold
  • Dressing in layers when going outside in cold weather
  • Using hand and foot warmers
  • Avoiding drug and alcohol use
  • Drinking plenty of water

RESOURCES:

Family Doctor—American Academy of Family Physicians
https://familydoctor.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES:

Canadian Dermatology Association
https://dermatology.ca
Environment and Climate Change Canada
http://www.ec.gc.ca

References:

Frostbite. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/disasters/winter/staysafe/frostbite.html. Accessed March 24, 2021.
Frostbite. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/frostbite. Accessed March 24, 2021.
Frostbite and frostnip. Kids Health—Nemours Foundation website. Available at:
...(Click grey area to select URL)
Accessed March 24, 2021.
McIntosh SE, Freer L, et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness Environ Med. 2019 Jul 17 early online.
Last reviewed December 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD
Last Updated: 03/24/2021

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