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Frostbite occurs when the skin and underlying tissues freeze, resulting in injury. In its early stage, known as frostnip, it causes a cold sensation followed by numbness. As frostbite progresses, the affected skin may change color and appear hardened or waxy.
Exposed skin in cold and windy conditions is particularly vulnerable to frostbite. Frostbite can also develop on skin that is covered by gloves or other clothing. Sometimes, frostbite may not be recognized until someone else points it out.
Mild frostbite can often be treated with rewarming, but more severe cases of frostbite require medical attention due to the potential for permanent damage to the skin, muscles, bones, and other tissues.
Symptoms
Signs and symptoms of frostbite encompass:
- Numbness
- A tingling sensation
- Cold skin
- Skin appearing hard or waxy in texture
- Pain
- Clumsiness attributed to stiffness in joints
- Possible blistering upon rewarming, particularly in severe cases
- Skin displaying hues such as red, white, bluish-white, grayish-yellow, purplish, brown, or ashen, contingent on the seriousness of the condition and the individual’s typical skin color
Frostbite predominantly affects areas such as the fingers, toes, nose, ears, cheeks, chin, and penis. Due to numbness in the skin, individuals may not be aware of frostbite until someone else brings it to their attention. Discerning changes in the color of the affected region can be challenging, especially on brown or Black skin.
The progression of frostbite unfolds in multiple stages:
- Frostnip. Frostnip is the initial stage of frostbite characterized by symptoms such as pain, tingling, and numbness. Frostnip does not result in lasting damage to the skin
- Superficial frostbite. Superficial frostbite induces minor alterations in skin color. The skin may start to feel warm, indicating serious skin involvement. If you attempt rewarming treatment for frostbite at this stage, the skin surface may appear patchy. Sensations of stinging, burning, and swelling may become apparent, and a fluid-filled blister might emerge 12 to 36 hours after the skin has been warmed.
- Deep (severe) frostbite. Advancing through its stages, frostbite impacts not only the outer layers of the skin but also the underlying tissues. The affected skin can change color to white or blue-gray. Large blood blisters may develop within 24 to 48 hours after rewarming. Over the following weeks, the tissue may darken and harden as it dies. Sizable blood blisters may develop within 24 to 48 hours after the rewarming process. Over the following weeks, the tissue may darken and harden as it dies.
If you suspect frostbite, it’s crucial to have it evaluated by a healthcare professional to assess the severity. Seek emergency care if you experience:
- Persistent, severe pain despite pain relievers and rewarming
- Intense shivering
- Slurred speech
- Extreme drowsiness
- Difficulty walking
Frostbite can also be accompanied by hypothermia. Symptoms of hypothermia include shivering, slurred speech, and unusual sleepiness or clumsiness. In babies, symptoms of hypothermia include cold skin, color changes, and very low energy. Hypothermia is a critical condition where the body loses heat faster than it can generate it.
Causes
Frostbite occurs when skin and underlying tissues freeze, often due to exposure to cold weather. However, it can also result from direct contact with ice, freezing metals, or extremely cold liquids. Factors contributing to frostbite include:
- Inappropriate clothing for the conditions, such as inadequate protection against cold, wind, or wet weather, or clothing that is too tight.
- Prolonged exposure to cold and windy conditions.When the wind chill is -15°F (-26°C) or lower, frostbite can develop in 30 minutes or less.
Risk factors
The risk of frostbite is heightened by the following factors:
- Infancy or advanced age, as both age groups may face challenges in generating and retaining body heat
- Alcohol or drug use
- Smoking
- Exposure to freezing temperatures without protective clothing.
- Being in cold conditions at a high altitude.
- Impaired judgment in extremely cold conditions.
- Prior history of frostbite or cold-related injuries
- Possess an existing medical condition such as peripheral vascular disease, malnutrition, Raynaud’s syndrome, hypothyroidism, arthritis, or diabetes.
Diagnosis
Diagnosing frostbite involves assessing signs and symptoms, observing skin appearance, and reviewing recent exposure to cold activities. In some cases, additional imaging tests such as X-rays, bone scans, or MRIs may be requested by your doctor to evaluate the severity of frostbite and detect any potential bone or muscle damage.
Treatment
Frostnip, or mild frostbite, can be addressed at home with initial first-aid measures. In cases of more severe frostbite, following appropriate first aid and evaluation for hypothermia, medical intervention may include processes such as rewarming, medication, wound care, surgery, and diverse therapies, tailored to the severity of the injury.
- Rewarming the skin: If the skin hasn’t been previously rewarmed, your doctor will use a warm-water bath for 15 to 30 minutes. This may result in the skin becoming soft, and you might be advised to gently move the affected area during the rewarming process.
- Protecting the injury: After the skin thaws, your doctor may loosely wrap the area with sterile sheets, towels, or dressings for protection. You may be instructed to elevate the affected area to minimize swelling.
- Oral pain medication: Due to the potential pain associated with rewarming, your doctor is likely to prescribe pain-relieving medication.
- Whirlpool therapy or physical therapy: Soaking in a whirlpool bath can aid healing by promoting cleanliness and natural removal of dead tissue.
- Removal of damaged tissue (debridement): To facilitate proper healing, frostbitten skin should be rid of damaged, dead, or infected tissue.
- Infection-fighting medications: If signs of infection appear on the skin, your doctor may prescribe oral antibiotics.
- Medications: In severe cases, you may receive an intravenous injection of a thrombolytic drug, such as Tissue Plasminogen Activator (TPA), to restore blood flow. Studies suggest that TPA can lower the risk of amputation in severe frostbite cases, but its use is limited due to the potential for serious bleeding, typically administered within 24 hours of exposure.
- Wound care: Various wound care techniques may be employed depending on the extent of the injury.
- Surgery: Individuals with severe frostbite may eventually require surgery or amputation to eliminate dead or decaying tissue.
- Hyperbaric oxygen therapy: Involves breathing pure oxygen in a pressurized room. Some patients have shown improved symptoms with this therapy, healing faster by increasing their blood-oxygen levels.
