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Frostbite: Causes, Symptoms, Stages, Risk Factors, Diagnosis, Complications And Treatment

Frostbite can be termed as an injury, caused due to exposure to extreme or prolonged cold. Your skin and the underlying tissues get affected and commonly affects the fingers, toes, nose, ears, cheeks and chin. Exposed skin in cold, windy weather is most vulnerable to frostbite, where in extreme cases of cold can result in the muscles, nerves, and blood vessels also freezing [1] .

Frostbite can also occur when your skin comes in direct contact with extremely cold surfaces, which can cause the skin to immediately freeze; even if the skin is covered by gloves or clothing. Young children and the elderly are also more likely to suffer from frostbite. Frostbite in a milder form is termed as frostnip and it does not cause any permanent skin damage [2] . Let's read more about frostbite in this article.

Causes Of Frostbite

The condition occurs when the skin and underlying tissues freeze, due to extreme cold weathers. The most common cause of frostbite is exposure to cold-weather conditions, with direct contact with ice, frozen metal or very cold liquids being the less common causes.

Some specific causes of frostbite are as follows [3] :

  • Touching materials such as ice, cold packs or frozen metal
  • Staying out in the cold and wind too long (when the temperature is below -15°C)
  • Wearing clothing that isn't suitable for the conditions

Symptoms Of Frostbite

The most common signs of the condition are as follows [4] :

  • Cold skin and a prickling feeling
  • Numbness
  • Clumsiness due to joint and muscle stiffness
  • Discolouration of skin
  • Pain around the exposed/affected area

In severe cases, the following symptoms can arise [5] :

  • Blisters on the skin
  • Skin turns black
  • Joints and muscles are stiff or not functioning
  • Fever
  • Hard or waxy-looking skin
  • Dizziness
  • Swelling and discharge from the affected area

If you have the following signs and symptoms, seek medical attention immediately:

  • Signs and symptoms of superficial or deep frostbite (reddened skin that turns pale or yellow)
  • Increased pain, swelling, redness or discharge in the area that was frostbitten
  • Fever
  • New, unexplained symptoms
  • Intense shivering
  • Slurred speech
  • Loss of coordination

Stages Of Frostbite

Frostbite occurs in several stages and they are as follows [3] :

  • Frostnip (first-degree): Very mild in nature, frostnip does not damage the skin. It causes the skin to turn red and feel cold to the touch. Frostnip can be treated with simple first-aid measures that include preventing further exposure to cold and rewarming.
  • Superficial frostbite (second-degree frostbite): This stage causes the skin to turn from a reddish colour to a paler colour. In some cases, it may appear blue. Ice crystals may begin to form in your skin and the affected area may have a hard or frozen feeling when you touch it.
  • Deep frostbite (third-degree frostbite): It is the most severe stage of frostbite and affects both your skin and the tissues that lie below, and causes the skin to have a blue or splotchy look to it.

Risk Factors For Frostbite

The following factors increase the risk of frostbite [6] :

  • Beta-blocker medications
  • Medical conditions such as depression, diabetes, cardiovascular disease or peripheral vascular disease
  • Smoking (it narrows blood vessels and slows down circulation, allowing frostbite to advance rapidly)
  • Fatigue, hunger, dehydration, physical labour and injury
  • Not properly dressed for the weather
  • Previous frostbite or cold injury
  • Fear and panic

Diagnosis Of Frostbite

Most cases of frostbite are diagnosed based on a physical exam. The treatment for the condition depends on where, when, and how the frostbite occurred.

The doctor may conduct tests, such as an X-ray, a bone scan or an MRI, which will help the doctor determine the severity of your frostbite and check for bone or muscle damage[7] .

Complications Of Frostbite

  • Infections
  • Changes in skin colour
  • Joint stiffness[8]
  • Long-term numbness in the affected area
  • Increased sensitivity to cold
  • Excessive sweating
  • Tetanus
  • Gangrene
  • Hypothermia [9]
  • Increased risk of developing frostbite again
  • Changes in or loss of nails
  • Growth defects in children, if frostbite damages a bone's growth plate

Treatment For Frostbite

Minor frostbite can be treated at home with basic first-aid measures, such as the following [10] :

  • Seek shelter from the cold
  • Warm your hands by tucking them under your arms
  • If you think you're dehydrated, drink warm drinks
  • Avoid sources of heat such as lamps, fire, or heating pads, as these can burn frostbitten skin
  • If possible, go indoors and remove wet clothing and jewellery
  • Once inside, place your hands and feet in warm water, and cover the rest of your body with a blanket

For severe cases, treatment may involve rewarming, medications, wound care, surgery and various therapies, depending on the severity of the injury and they are as follows [11] :

  • Oral pain medicine
  • Removal of damaged tissue (debridement)
  • Whirlpool therapy or physical therapy
  • Infection-fighting drugs
  • Clot-busting drugs
  • Wound care, depending on the extent of the injury
  • Surgery
  • Hyperbaric oxygen therapy

Prevention Of Frostbite

  • Limit time you're outdoors in cold, wet or windy weather
  • Wear a hat or headband that fully covers your ears [12]
  • Dress in several layers of loose, warm clothing
  • Wear socks and sock liners that fit well, provide insulation and does not trap moisture
  • Wear mittens rather than gloves
  • Don't drink alcohol if you plan to be outdoors in cold weathers
  • Eat well-balanced meals and stay hydrated
View Article References
  1. [1] Murphy, J. V., Banwell, P. E., Roberts, A. H., & McGrouther, D. A. (2000). Frostbite: pathogenesis and treatment. Journal of Trauma and Acute Care Surgery, 48(1), 171.
  2. [2] Makhni, M. C., Makhni, E. C., Swart, E. F., & Day, C. S. (2017). Frostbite. In Orthopedic Emergencies (pp. 515-516). Springer, Cham.
  3. [3] Handford, C., Thomas, O., & Imray, C. H. (2017). Frostbite. Emergency Medicine Clinics, 35(2), 281-299.
  4. [4] Gonzaga, T. P., Jenabzadeh, K., Anderson, C. P., Mohr, W. J., Endorf, F. W., & Ahrenholz, D. H. (2016). Use of intra-arterial thrombolytic therapy for acute treatment of frostbite in 62 patients with review of thrombolytic therapy in frostbite. Journal of Burn Care & Research, 37(4), e323-e334.
  5. [5] Millet, J. D., Brown, R. K., Levi, B., Kraft, C. T., Jacobson, J. A., Gross, M. D., & Wong, K. K. (2016). Frostbite: spectrum of imaging findings and guidelines for management. Radiographics, 36(7), 2154-2169.
  6. [6] Stewart, J., Goodman, L. R., Rabbitts, A., & Heffernan, J. (2019). 428 Bitter Cold: The Impact of Frostbite on Vulnerable Populations. Journal of Burn Care & Research, 40(Supplement_1), S186-S187.
  7. [7] Mullen, M., Zachary, T., Foley, R., & Irani, Z. (2019). Thrombolysis for Frostbite: A Case Study and Clinical Considerations. Journal of Radiology Nursing.
  8. [8] Cochran, A., & Morris, S. E. (2018). Cold-induced injury: frostbite. In Total Burn Care (pp. 403-407). Elsevier.
  9. [9] Cauchy, E., Davis, C. B., Pasquier, M., Meyer, E. F., & Hackett, P. H. (2016). A new proposal for the management of severe frostbite in the austere environment. Wilderness & environmental medicine, 27(1), 92-99.
  10. [10] Nygaard, R. M., Whitley, A. B., Fey, R. M., & Wagner, A. L. (2016). The Hennepin score: Quantification of frostbite management efficacy. Journal of Burn Care & Research, 37(4), e317-e322.
  11. [11] Fudge, J. (2016). Exercise in the cold: preventing and managing hypothermia and frostbite injury. Sports health, 8(2), 133-139.
  12. [12] Terrill, P. J., Tong, K. S., & Williams, D. (2019). Frostbite following cryolipolysis: a case report. Australasian Journal of Plastic Surgery, 2(1), 110-113.

Story first published: Thursday, November 28, 2019, 12:30 [IST]
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