Frostbite

Frostbite is damage to the skin caused by exposure to cold temperatures. Frequently, single-digit temperatures are enough to cause frostbite, especially when paired with low wind chill. The colder the temperature, the faster frostbite symptoms can set in.

Find specialized treatment
Man carrying a child piggybackMan carrying a child piggybackTwo people pose in a sledding selfie

Frostbite symptoms and risk factors

What are the symptoms of frostbite?

The following are the most common symptoms of frostbite:

  • Redness or pain in the affected area.
  • White or grayish-yellow skin.
  • Skin that feels abnormally firm or waxy.
  • Numbness.
  • Blisters (filled with clear fluid or possibly blood-filled in more severe cases).
  • Black, dead skin and tissues (gangrene) in severe cases.

In most cases, the person is unaware of frostbite because the frozen tissues are numb.

The symptoms of frostbite may look like other health conditions or problems. Always check with your healthcare provider for a diagnosis.

Those most at risk

  • Young children.
  • Older adults.
  • Homeless people.
  • People with circulatory problems.
  • People who are impaired by alcohol or drugs.
  • People who take medication for high blood pressure.
  • People who have diabetes.
snowboarder walking with board

Stages of frostbite

Frostnip

Frostnip is a mild stage of frostbite. In this stage, the affected area turns red and could feel numb, tingly, itchy or cold. Frostnip doesn’t damage the skin and can be treated with simple first aid:

  • Prevent additional exposure to the cold.
  • Rewarm the affected area in warm (not hot) water for 15 to 30 minutes.
  • Use over-the-counter pain medication like ibuprofen if the affected area is painful upon warming.
Ice climber on crevice wall

Superficial frostbite

Superficial frostbite is the second stage. In this stage, the skin will go from reddish to pale and might even appear blue. Ice crystals might begin to form on the affected area, the skin might feel warm and the area might swell, which is a sign that damage to the tissue is occurring.

Typically, within 12 to 36 hours after the area has thawed, the skin will form painful blisters. Although only the top layer of the skin is impacted during this stage, prompt medical attention is necessary to prevent further tissue damage.

Deep frostbite

Deep frostbite impacts all layers of the skin. The skin will turn bluish-gray, and the affected area may feel numb, with no sense of cold, pain or discomfort. If it’s deep enough, joints and muscles might be impacted.

Within 24 to 48 hours after the area has thawed, large blisters will form, later turning black and hard as the tissue dies.

First aid for frostbite

If you notice signs of frostbite, take steps to address it. If the symptoms indicate superficial or deep frostbite or if you’re not sure, be sure to contact medical help immediately.

  • Prevent further exposure to the cold.
  • Rewarm the area in warm water for 15 to 30 minutes.
  • Keep the affected area elevated to reduce swelling.
  • Use over-the-counter pain medication like if the affected area is painful upon warming.
  • Try to avoid walking on frostbitten feet.
Skier cutting hard

Remember that a person who is experiencing frostbite might also have hypothermia, which can be deadly. If you observe the following symptoms, seek medical attention immediately.

  • Shivering.
  • Exhaustion.
  • Slurred speech.
  • Drowsiness.
  • Confusion.

Frostbite treatment and recovery

Medical treatment

After addressing any life-threatening issues, the doctor will focus on rewarming the affected area. This process is painful, so you might be given narcotic pain relievers and, if dehydration is an issue, IV fluids.

After rewarming, the doctor will take care of other aspects of the frostbite:

  • Debriding (remove dead tissue from) the frostbitten area.
  • Performing imaging tests such as MRI to determine how deep the damage goes.
  • Addressing extreme damage (blackened skin and areas blood circulation won’t return to) by amputating as needed.
  • Dealing with infection by prescribing antibiotics.

UCHealth burn and frostbite caregivers have added a tPA (blood thinner) protocol to increase blood flow. This treatment protocol drastically reduces digit-amputation rate.

Factors affecting recovery

Your recovery time will depend on how severe your frostbite is. It might take one to two months to determine the full extent of tissue damage from the event. After you leave the hospital, follow smart aftercare protocols:

  • Avoid alcohol and smoking, as both impair healing.
  • Avoid sun damage to the frostbitten area by wearing protective clothing and sunscreen.
  • Do not rub or massage the damaged area.
  • Drink liquids as directed.
  • Keep the damaged area elevated above your heart as much as possible.
  • Leave blisters and other sores alone.
  • Reduce exposure to cold temperatures.
  • Take all medications as prescribed.

And just as importantly, keep your follow-up appointments with your doctor.

Frequently asked questions (FAQs) about frostbite

How does a provider diagnose frostbite?

A healthcare provider will ask about your exposure to the cold and look at symptoms, such as the condition of your skin. The provider will ask if you have a health condition that may put you at risk for frostbite. To fully assess the level of tissue damage (particularly to bone or muscle) and help guide treatment, the doctor might run tests, including X-ray, bone scan or MRI.

What are some proven ways to prevent frostbite?

Avoid frostbite by staying safe and warm.

  • Wear warm clothes that aren’t too tight.
  • Wear a hat or headband that covers your ears.
  • Wear insulated mittens or gloves.
  • Choose waterproof footwear.
  • Limit your time outside if possible.
  • Avoid alcohol or drug use, which can impair your sense of cold.
  • Check for early signs of frostnip or frostbite.

Children are especially vulnerable

Children are very susceptible to frostbite, so prevention is a must. Never put an ice pack directly on a child’s skin. Instead, wrap the pack in a clean, thin cloth. In cold weather:

  • Dress children in warm but loose layers.
  • Be sure to cover exposed areas such as hands, feet, ears and chin.
  • Change any wet clothing, including socks, hats, and mittens or gloves.
  • Bring children inside frequently to warm up. Check them for early signs of frostnip or frostbite.
Are there any long-term effects from having frostbite?

People who have had frostbite can experience additional complications, including:

  • An increased sensitivity to cold.
  • Numbness in the affected area(s).
  • Chronic pain in the affected area(s).
  • Reduced sense of touch in the area(s) impacted by frostbite.
  • Damage to muscles, tendons, nerves and bones.
  • Changes to nails, including weakness.
  • Changes to skin color.
  • Gangrene.
  • Arthritis in affected joints.

Furthermore, children who have had frostbite might experience growth defects.

References

National Library of Medicine. Frostbite (https://www.ncbi.nlm.nih.gov/books/NBK536914/)

Orthoinfo: American Academy of Orthopaedic Surgeons. Frostbite (https://orthoinfo.aaos.org/en/diseases–conditions/frostbite/)

MedlinePlus: National Library of Medicine. Frostbite (https://medlineplus.gov/ency/article/000057.htm)

Center for Disease Control and Prevention (CDC). Prevent Hypothermia & Frostbite (https://www.cdc.gov/disasters/winter/staysafe/hypothermia.html)