Frostbite

What Does Frostbite Look Like?

Frostbite can appear different depending on the stage of the condition.

No frostbite. No sign of frostbite; your skin appears normal. 

Frostnip (early stage). Gradual skin color changes, with skin looking red to purple. 

Superficial (intermediate stage) frostbite. You may have spotty patches, blisters, swelling, and itchiness after rewarming.

Deep (advanced stage) frostbite. Big blisters appear a day or two after rewarming.

Frostbite Symptoms

The signs of frostbite also vary according to the stage or severity of the frostbite. Symptoms might include:

• Pain
• Hardened, cold skin
• Tingling (like pins and needles) or numbness
• Patchy appearance to your skin, including a variety of colors like blue, purple, brown, or gray
• Stiff joints that lead to clumsiness
• Blisters or small red bumps after your skin is rewarmed 

What does frostbite feel like? 

At first, you have no symptoms. Your symptoms worsen as the condition moves through further stages.

Frostnip. The frostnip stage is when you start having symptoms. The frostbite feels like pain, tingling, and numbness in the affected skin.

Superficial frostbite. In superficial frostbite, you may experience burning, numbness, tingling, itching, or cold sensations in the affected areas. The regions appear white and frozen, but if you press on them, they retain some resistance. 

Deep frostbite. In deep frostbite, there is an initial decrease in sensation that is eventually completely lost. Swelling and blood-filled blisters are noted over white or yellowish skin that looks waxy and turns a purplish blue as it rewarms. The area is hard, has no resistance when pressed on, and may even appear blackened and dead.

You will experience significant pain as the areas are rewarmed and blood flow is reestablished. A dull continuous ache transforms into a throbbing sensation in 2-3 days. This may last weeks to months until final tissue separation is complete.

How Do You Know if You Have Frostbite?

You should see a doctor if you think you have frostbite. Seek emergency medical care if you have any symptoms of hypothermia, such as shivering that won't stop, you should seek emergency medical care right away.

A doctor must be able to see and check the affected area. A simple phone call is probably not enough in all but the mildest cases of cold injury to hands and feet. You need to see a doctor for care.

At the time of your first evaluation, it's very hard to tell if the injury is superficial or deep, and even more difficult to confirm the extent of tissue damage. Therefore, everyone with a frostbite injury should see a doctor, who will supervise the rewarming process, try to classify the injury, and further guide the treatment process. Someone with frostbite will need to be checked and treated for hypothermia and dehydration.

Frostbite Diagnosis

Your doctor will review your medical history to gather information on the events of the exposure and your health before the cold injury.

They will take note of your vital signs, including temperature, pulse, blood pressure, and respiratory rate so that they can rule out or treat any immediate life threats such as hypothermia or severe infection. Depending on your symptoms, your doctor may have an X-ray or other imaging tests done to look at the tissue underneath your skin.

The doctor will also classify the condition as superficial or deep and whether the outcome of your frostbite will be favorable or poor. Normal skin color, blisters with clear fluid, the ability to deform the skin with pressure, and the skin becoming pink when thawed are signs that the skin damage may be temporary. Blisters with dark fluid, skin turning dark blue when thawed, and being unable to indent the skin with pressure are signs of permanent skin damage.

Frostbite Treatment

How you handle frostbite depends on the stage of the condition.

Frostbite first aid

If you think you may have hypothermia, seek emergency help right away. If you're showing signs of frostnip, you should:

• Move to a warm area to prevent further heat loss.
• Remove all your jewelry (because they may further block blood flow) and replace wet gear or clothing with dry clothes.
• Never rewarm an affected area if there is any chance it may freeze again (the thaw-refreeze cycle is very harmful).
• If you're able to, soak the affected area in warm water, or use body heat to warm the area, for about 30 minutes.
• Keep the affected part elevated to reduce swelling.
• Drink warm, nonalcoholic, and noncaffeinated fluids.
• Keep the injured part away from direct sources of heat until you arrive at a treatment facility where proper rewarming can take place.
• Do not rub the frozen area with snow (or anything else, for that matter). The friction created by this technique will only cause further tissue damage.
• Avoid walking if your feet or toes are frostbitten.

Above all, keep in mind that the final amount of tissue damage is directly related to the time it stays frozen, not to thetemperature to which it was exposed. Therefore, getting to a hospital quickly is very important.

Medical treatment for frostbite

Your doctor will try to treat frostbite in the following ways:

• Use a water bath heated to 40-42 C (104-107.6 F) and continue until the thaw is complete (usually 30 minutes). 
• Recommend narcotic pain medications for you because this process is very painful.
• Give IV fluids because dehydration is very common.

After rewarming, post-thaw care is provided to prevent infection and a continuing lack of oxygen to the area. This process includes:

Care for blisters. Small clear blisters are left intact. Draining is sometimes recommended for blisters that are cloudy or white, and blisters that are bloody may be left intact to protect the underlying blood vessels and decrease the risk of infection.

A tetanus booster. This may be needed because people with frostbite are at risk of developing bacterial infections.

Hospital care. People with frostbite are hospitalized for at least one to two days to determine the extent of injury and to receive further treatment, which may include:

• Aloe vera cream. This cream is applied every six hours, and the area is elevated and splinted.
• Ibuprofen. This medication may be given to combat inflammation, and an antibiotic may be given if an infection develops.
• Water therapy. For deep frostbite, you may be treated with daily water therapy in a 37-39 C (98.6-102.2 F) whirlpool bath to remove any dead tissue.

Several experimental therapies also exist, many of which aim to further treat the inflammation or decreased blood flow seen in frostbite.

Frostbite Recovery

Frostbite symptoms usually follow the same course. At first, you'll feel numbness, followed by a throbbing feeling that happens with rewarming and may last weeks to months. This is then typically replaced by a persistent tingling with occasional electric shock sensations. Cold sensitivity, sensory loss, chronic pain, and a variety of other symptoms may last for years.

The treatment of frostbite is done over a period of weeks to months. Definitive therapy, possibly in the form of surgery, may not be performed for up to six months after the initial injury. 

Is frostbite permanent?

It often takes months before doctors can find out which tissue is healthy or dead. If surgery is performed too early, there is a high risk of removing tissue that might recover or leaving behind tissue that may die. Researchers are exploring new imaging techniques that may be able to identify this sooner, allowing for earlier definitive treatment. In some cases, bone scans are used to help predict the viability of tissue.

How to Prevent Frostbites

The first step in preventing frostbite is knowing whether you're at increased risk for the condition.

People who are more at risk of getting frostbite include:

• Infants or older adults, whose bodies can't control body temperature as well
• People who are homeless
• Those who take certain medications that narrow blood vessels
• Those who smoke
• Workers who have to work outdoors for long periods, such as rescue workers
• Those who enjoy winter sports such as skiing or hiking mountains
• People with certain medical conditions that cause trouble with circulation (such as diabetes)

You can prevent the risk of frostbite in many ways, including:

Staying indoors and limiting your time outside. If the temperature is freezing or below, consider staying inside.

Dressing for the weather. It's best to layer your clothing and cover your head, ears, nose, and face when preparing to be in freezing temperatures. Mittens, socks, layered socks, and waterproof shoes are important items to wear to prevent frostbite.

Avoiding poor circulation. Be sure that your clothing and gear are loose enough for your body to keep good blood flow.

Although people don't always know or acknowledge these dangers, many of the dangers can be reduced or prevented.

Don't travel alone. Always travel with a friend in case help is needed.

Avoid smoking and alcohol. Many cases of frostbite are seen in people who drink alcohol, misuse recreational drugs, have a psychiatric condition, or have car accidents or car breakdowns in bad weather. All of these situations involve the risk of cold exposure and either the unwillingness or inability of a person to remove themselves from this threat.

You should also be especially wary of wet and windy conditions. The "feels like" temperature (windchill) is much lower than the stated air temperature.

Takeaways

Frostbite occurs when cold temperature freezes your skin and the tissues under it. It often involves your nose, cheeks, ears, fingers, and toes. See a doctor immediately if you’ve been out in cold weather and show symptoms, such as pain and numbness in your skin and blisters after rewarming. They’ll rewarm your body and give you pain relief, a tetanus shot, and other therapies as needed. You may also have to stay in the hospital for a day or two to see how much injury you have and get more treatment.

Frostbite FAQs

What is the difference between hypothermia and frostbite?

Hypothermia, like frostbite, is a medical emergency caused by exposure to cold. It causes your skin temperature to drop dangerously low, below 95 F. It affects your entire body rather than certain skin areas, causing symptoms such as shivering, exhaustion, sleepiness, and weak pulse. It can also cause health problems including heart attacks, liver damage, kidney problems, or death.

How long does it take for you to get frostbite?

When it’s freezing outside, you can get frostbite within 30 minutes, especially if the wind chill is at −15 F or lower. If the temperature outside is 5 F with strong winds, you can get frostbite after being outside for less than an hour.

What temperatures can cause frostbite?

Frostbite can occur when the temperature drops to 5 F or below.

How to avoid frostbite on your face

Cover your face with a scarf or face mask. Wear a heavy wool or fleece hat over your head and ears.

How to treat freezer burn on skin

You can treat a frostbite burn by rewarming the area with a warm washcloth or water. You can also apply burn ointment and a bandage to open blisters, but you should still see a doctor immediately.