Cold Induced Injury Frostbite

Frostbite occurs when exposure to cold temperatures damages the skin or other tissues.

What are the causes and risks of the injury?

Anyone who is exposed to extreme cold for a significant length of time has a risk of developing frostbite. Windy weather may contribute to frostbite, too, by blowing body heat away from the body.

Frostbite occurs more often among:

those who work outside in extremely cold areas

mountain climbers

people who are caught in the elements without proper clothing

people taking certain medications, such as beta-blockers, that decrease the blood flow to the skin

smokers

people who have blocked arteries, atherosclerosis or other problems that affect blood circulation

people with diabetes

people with nerve problems that decrease their ability to feel injuries in certain parts of the body, a condition called neuropathy

What are the signs and symptoms of the injury?

After exposure to cold, a person may initially notice the symptoms of frostnip, or mild frostbite, which include:

a prickly sensation, or pins and needles

mild numbness

reddened, painful skin

In severe frostbite, a person may notice:

blisters on the skin

hard, white skin which is completely numb

blackened skin, known as gangrene, which means the tissue has died

How is the injury recognized?

Usually, a healthcare provider diagnoses frostbite if:

a person reports exposure to extreme cold and a feeling of pins and needles followed by numbness

skin in the injured area has a change in color or thickness

What can be done to prevent the injury?

Prevention is the key to avoiding frostbite. When a person is in very cold areas for long periods of time, he or she should:

stop smoking and drinking alcohol

wear warm, multilayered, dry clothing that fits loosely, as tight clothes tend to be less warming and can cut down circulation

avoid high, windy areas

stay warm through activity

take necessary precautions to prevent cold exposure

If a person should get wet in cold weather, it is important to dry off quickly and change clothes right away.

What are the treatments for the injury?

If a person may have frostbite, it is important to:

bring him or her to a warmer spot

remove any wet or constricting clothing

thaw the area by putting it into warm water that is less than 110 F for at least 20 minutes, if possible. This thawing may cause the affected person pain or discomfort, but it is important.

apply gauze dressings to the frostbitten area, if available, wrapping each toe or finger separately

move the area as little as possible

try to keep the area warm so that it will not freeze again

seek medical attention

There are several things to avoid when treating frostbite. A person should not:

rub or massage the affected area

break any blisters that are present

use hot water or direct heat such as hair dryers, radiators or fires to warm the frostbitten areas

A healthcare provider will continue treatment as needed. Pain and infection of the infected skin areas are fairly common problems from the injury. Pain may require prescription-strength pain medications in some cases. Antibiotics may be required for infection, which are usually given topically.

Surgical treatment may be needed in some cases, but is often delayed. This is because most severe cold injury is more superficial than it seems, and often causes less tissue loss than predicted. Sometimes the frostbitten areas are large or severe enough to require a skin graft or even amputation of the affected area.

What are the side effects of the treatments?

All medications cause side effects, such as allergic reactions or stomach upset. Surgery carries a risk of infection, bleeding or even death.

What happens after treatment for the injury?

After recovery, a person can generally return to normal activities.