Frostbite is an injury that can happen in a situation of extreme cold. In frostbite, body tissues become frozen, and permanent damage may happen if the affected area is not treated promptly. Amputation of a body part may be needed in the most severe cases. Most commonly, affected body parts include the nose, ears, fingers, toes, cheeks, and chin. Some conditions may lead to an increased risk for frostbite, such as: Reduced blood circulation from conditions, such as peripheral arterial disease (PAD), diabetes, peripheral neuropathy, or Raynaud phenomenon Constricted blood flow to the extremities due to gloves, boots, socks, or other clothing items that are too tight Lack of appropriate clothing to match weather conditions Windy conditions, which cause more rapid cooling of the skin and body Certain medicines like beta
blockers Smoking Alcohol or drug intoxication that results in prolonged exposure to extreme cold The following are the most common symptoms of frostbite: Redness or pain in a skin area A white or grayish-yellow skin areaWhat is frostbite?
What are the symptoms of frostbite?
Skin that feels unusually firm or waxy
Numbness
Blisters (filled with clear fluid or possibly blood-filled in more severe cases)
Gangrene (black dead skin and tissues) in severe cases
In most cases, the victim is unaware of frostbite because the frozen tissues are numb. The symptoms of frostbite may look like other medical conditions or problems. Always check with your healthcare provider for a diagnosis.
What to do if frostbite happens
If there are symptoms of frostbite, seek medical attention immediately. Frostbite and hypothermia both result when skin is exposed to cold surroundings and body temperature falls. Hypothermia is a more serious medical condition and needs emergency medical assistance.
If frostbite happens, protect the victim or yourself with the following recommendations:
Get into a warm room as soon as possible. Remove any wet clothing.
Cover the person or area in warm blankets.
Avoid walking on frostbitten feet or toes to avoid more serious damage.
Immerse the areas affected by frostbite into warm (not hot) water until normal skin color returns. Do not soak the affected area too long (no more than 30 minutes).
Warm the affected area using body heat.
Do not rub or massage the affected area as this can cause further damage.
Do not use anything hot, such as a heating pad, stove, or furnace, to warm the affected area, as these areas are numb and may burn easily due to a lack of sensation.
The frostbitten area should be gently washed, dried, and wrapped in sterile bandages and kept clean to avoid infection.
Consult your healthcare provider about the use of an oral antibiotic or topical ointment.
Because refreezing of thawed tissue can worsen damage to the tissue, it is very important that thawing of frostbitten tissues not be attempted unless it is certain that refreezing will not happen. Delay thawing frozen tissue until a safe and warm location can be reached.
A frostbite condition is most often resolved over a period of weeks or months. Sometimes, however, surgery is later needed to remove the dead tissue.
Overview
Frostbite is an injury caused by freezing of the skin and underlying tissues. In the earliest stage of frostbite, known as frostnip, there is no permanent damage to skin. Symptoms include cold skin and a prickling feeling, followed by numbness and inflamed or discolored skin. As frostbite worsens, skin may become hard or waxy-looking.
Exposed skin in cold, windy weather is most vulnerable to frostbite, but it can affect skin covered by gloves or other clothing. You may not realize you have frostbite until someone else points it out.
You can treat frostnip by rewarming. All other frostbite requires medical attention because it can permanently damage skin, muscle, bone and other tissue.
Symptoms
Signs and symptoms of frostbite include:
- At first, cold skin and a prickling feeling
- Numbness
- Skin that looks red, white, bluish-white, grayish-yellow, purplish, brown or ashen, depending on the severity of the condition and usual skin color
- Hard or waxy-looking skin
- Clumsiness due to joint and muscle stiffness
- Blistering after rewarming, in severe cases
Frostbite is most common on the fingers, toes, nose, ears, cheeks and chin. Because of skin numbness, you may not realize you have frostbite until someone points it out. Changes in the color of the affected area might be difficult to see on brown or Black skin.
Frostbite occurs in several stages:
- Frostnip. Frostnip is a mild form of frostbite. Continued cold exposure leads to numbness in the affected area. As your skin warms, you may feel pain and tingling. Frostnip doesn't cause permanent skin damage.
- Superficial frostbite. Superficial frostbite causes slight changes in skin color. The skin may begin to feel warm — a sign of serious skin involvement. If you treat frostbite with rewarming at this stage, the surface of the skin may appear mottled. And you may notice stinging, burning and swelling. A fluid-filled blister may appear 12 to 36 hours after rewarming the skin.
- Deep (severe) frostbite. As frostbite progresses, it affects all layers of the skin as well as the tissues that lie below. The skin turns white or blue-gray and you lose all sensation of cold, pain or discomfort in the area. Joints or muscles may stop working. Large blisters form 24 to 48 hours after rewarming. The tissue turns black and hard as it dies.
When to see a doctor
Seek medical attention for frostbite if you experience:
- Signs and symptoms of superficial or deep frostbite
- Increased pain, swelling, inflammation or discharge in the area that was frostbitten
- Fever
- New, unexplained symptoms
Seek emergency care for hard, cold, blotchy skin.
Also get emergency medical help if you suspect hypothermia, a condition in which the body loses heat faster than it can be produced. Signs and symptoms of hypothermia include:
- Intense shivering
- Slurred speech
- Drowsiness and loss of coordination
Wrap the person with hypothermia in warm blankets until help arrives.
What you can do in the meantime
While you wait for emergency medical help or a doctor's appointment, take appropriate self-care measures, such as:
- Removing wet clothing
- Protecting the affected area from further cold
- Not walking on frostbitten feet
- Reducing pain with a pain reliever
Causes
Frostbite occurs when skin and underlying tissues freeze. The most common cause of frostbite is exposure to cold-weather conditions. But it can also be caused by direct contact with ice, freezing metals or very cold liquids.
Specific conditions that lead to frostbite include:
- Wearing clothing that isn't suitable for the conditions you're in — for example, it doesn't protect against cold, windy or wet weather or it's too tight.
- Staying out in the cold and wind too long. Risk increases as air temperature falls below 5 F (minus 15 C), even with low wind speeds. In wind chill of minus 16.6 F (minus 27 C), frostbite can occur on exposed skin in less than 30 minutes.
Risk factors
The following factors increase the risk of frostbite:
- Medical conditions that affect your ability to feel or respond to cold, such as dehydration, excessive sweating, exhaustion, diabetes and poor blood flow in the limbs
- Alcohol or drug use
- Smoking
- Fear, panic or mental illness that impairs your judgment
- Previous frostbite or cold injury
- Being an infant or older adult, both of whom may have a harder time producing and retaining body heat
- Being at high altitude, where there's less oxygen
Complications
Complications of frostbite include:
- Increased sensitivity to cold
- Increased risk of developing frostbite again
- Long-term numbness in the affected area
- Excessive sweating (hyperhidrosis)
- Changes in skin color
- Changes in or loss of nails
- Joint stiffness (frostbite arthritis)
- Growth problems in children, if frostbite damages a bone's growth plate
- Infection
- Tetanus
- Gangrene — decay and death of tissue resulting from an interruption of blood flow to the affected area — which can result in amputation
- Hypothermia
Prevention
Frostbite can be prevented. Here are tips to help you stay safe and warm.
- Limit time outdoors in cold, wet or windy weather. Pay attention to weather forecasts and wind chill readings. In very cold, windy weather, exposed skin can develop frostbite in a matter of minutes.
- Dress in several layers of loose, warm clothing. Air trapped between the layers of clothing acts as insulation against the cold. Wear windproof and waterproof outer garments to protect against wind, snow and rain. Choose undergarments that wick moisture away from the skin. Change out of wet clothing — particularly gloves, hats and socks — as soon as possible.
- Wear a hat or headband that fully covers the ears. Heavy woolen or windproof materials make the best headwear for cold protection.
- Wear mittens rather than gloves. Mittens provide better protection. Or try a thin pair of glove liners made of a wicking material (such as polypropylene) under a pair of heavier gloves or mittens.
- Wear socks and sock liners that fit well, wick moisture and provide insulation. Consider hand and foot warmers as well. Be sure foot warmers don't make boots too tight, restricting blood flow.
- Watch for signs of frostbite. Early signs of frostbite include changes in skin color, prickling and numbness. Seek warm shelter if you notice signs of frostbite.
- Plan to protect yourself. When traveling in cold weather, carry emergency supplies and warm clothing in case you become stranded. If you'll be in remote territory, tell others your route and expected return date.
- Don't drink alcohol if you plan to be outdoors in cold weather. Alcoholic beverages cause the body to lose heat faster.
- Eat well-balanced meals and stay hydrated. Doing this even before you go out in the cold will help you stay warm.
- Keep moving. Exercise can get the blood flowing and help you stay warm, but don't do it to the point of exhaustion.