eMedicine Specialties > Dermatology > Environmental

Frostbite: Follow-up

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Gregory E Rauscher, MD, Chairman Emeritus, Hackensack Medical Center; Professor, Department of Plastic Surgery, UMDNJ-New Jersey Medical School; Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers
Contributor Information and Disclosures

Updated: May 15, 2008

Follow-up

Deterrence/Prevention

  • Wearing several layers of warm clothing and avoiding exposure to water and wind are the best ways to prevent frostbite.
  • Covering the head is important because approximately 30% of heat loss occurs through the head.
  • Wearing dry gloves, socks, and boots are important to conserve heat.
  • Patients should maintain metabolic heat production by consuming ample food and fluids.
  • Drugs and alcohol often play a role in developing frostbite because they impair judgment.
  • People with Raynaud disease should be aware that they are more prone to frostbite because they may not feel the cold as much; they should take special care to prevent frostbite.

Complications

  • Peripheral circulation may be compromised, leading to gangrene and potential loss of the affected area.
  • Exposure to the cold may lead to hypothermia.
  • Long-term complications include paresthesia, sensitivity to cold, and faulty nail growth.
  • A third-degree ear burn was reported as a serious sequela of frostbite.5

Prognosis

  • If patients receive medical attention before much damage has taken place, the damage is reversible and the patient will fully recover.
  • If the damage is allowed to progress, the patient may develop long-lasting symptoms (eg, numbness, hypersensitivity to cold), or the patient may develop gangrene, and the affected area may have to be removed.

Patient Education

  • Educate patients to dress appropriately for cold weather (even if they feel they do not need to) because the damage frostbite can cause may be severe and permanent. At high altitude, mountaineers should wear appropriate clothing, have the necessary equipment (eg, high-quality boots and mittens), use a competent guide, and have training in how to survive in cold weather.6 People should avoid wearing wet clothing and windy terrain, and should not remain in the same position for long periods.
  • For excellent patient education resources, visit eMedicine's Environmental Exposures and Injuries Center. Also, see eMedicine's patient education article Frostbite.

Miscellaneous

Medicolegal Pitfalls

  • Failure to ensure that salvaging the affected area is not possible before amputating is a pitfall. Waiting as long as possible before amputation is advised but not at the cost of further deterioration of the patient's condition.
  • Frostbite risks tissue or extremity loss.
 


More on Frostbite

Overview: Frostbite
Differential Diagnoses & Workup: Frostbite
Treatment & Medication: Frostbite
Follow-up: Frostbite
References
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References

  1. Long WB 3rd, Edlich RF, Winters KL, Britt LD. Cold injuries. J Long Term Eff Med Implants. 2005;15(1):67-78. [Medline].

  2. Bilgiç S, Ozkan H, Ozenç S, Safaz I, Yildiz C. Treating frostbite. Can Fam Physician. Mar 2008;54(3):361-3. [Medline].

  3. Murat I. A Dangerous Sequele of Frostbite: Third-Degree Ear Burn. J Burn Care Res. Apr 10 2007;[Medline].

  4. Hassi J, Mäkinen TM. Frostbite: occurrence, risk factors and consequences. Int J Circumpolar Health. Apr 2000;59(2):92-8. [Medline].

  5. Hirvonen J. Some aspects on death in the cold and concomitant frostbites. Int J Circumpolar Health. Apr 2000;59(2):131-6. [Medline].

  6. Kahn JE, Lidove O, Laredo JD, Blétry O. Frostbite arthritis. Ann Rheum Dis. Jun 2005;64(6):966-7. [Medline].

  7. Bass M. Treatment of frostbite. Alaska Med. Jan-Mar 1993;35(1):141. [Medline].

  8. Bird D. Identification and management of frostbite injuries. Emerg Nurse. Dec-2000 Jan 1999;7(8):17-9. [Medline].

  9. Danielsson U. Windchill and the risk of tissue freezing. J Appl Physiol. Dec 1996;81(6):2666-73. [Medline].

  10. Hamlet MP. Prevention and treatment of cold injury. Int J Circumpolar Health. Apr 2000;59(2):108-13. [Medline].

  11. Harirchi I, Arvin A, Vash JH, Zafarmand V. Frostbite: incidence and predisposing factors in mountaineers. Br J Sports Med. Dec 2005;39(12):898-901; discussion 901. [Medline].

  12. Kanzenbach TL, Dexter WW. Cold injuries. Protecting your patients from the dangers of hypothermia and frostbite. Postgrad Med. Jan 1999;105(1):72-8. [Medline].

  13. Kappes B, Mills W, O'Malley J. Psychological and psychophysiological factors in prevention and treatment of cold injuries. Alaska Med. Jan-Mar 1993;35(1):131-40. [Medline].

  14. Lin DT. A study of local effect and global effect on the microthermal bio-flows by molecular dynamics. Int J Biol Macromol. Mar 16 2007;[Medline].

  15. Murphy JV, Banwell PE, Roberts AH, McGrouther DA. Frostbite: pathogenesis and treatment. J Trauma. Jan 2000;48(1):171-8. [Medline].

  16. Paton BC. A history of frostbite treatment. Int J Circumpolar Health. Apr 2000;59(2):99-107. [Medline].

  17. Pulla RJ, Pickard LJ, Carnett TS. Frostbite: an overview with case presentations. J Foot Ankle Surg. Jan-Feb 1994;33(1):53-63. [Medline].

  18. Reamy BV. Frostbite: review and current concepts. J Am Board Fam Pract. Jan-Feb 1998;11(1):34-40. [Medline].

  19. Rintamäki H. Predisposing factors and prevention of frostbite. Int J Circumpolar Health. Apr 2000;59(2):114-21. [Medline].

  20. Twomey JA, Peltier GL, Zera RT. An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite. J Trauma. Dec 2005;59(6):1350-4; discussion 1354-5. [Medline].

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Further Reading

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Keywords

frostnip, dermatitis congelationis, chilblains, trench foot

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Gregory E Rauscher, MD, Chairman Emeritus, Hackensack Medical Center; Professor, Department of Plastic Surgery, UMDNJ-New Jersey Medical School
Gregory E Rauscher, MD is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Laser Medicine and Surgery, International College of Surgeons, Medical Society of New Jersey, and Sigma Xi
Disclosure: Nothing to disclose.

Cris Jagar, MD, Staff Physician, Department of Psychiatry, Saint Vincent Catholic Medical Centers
Disclosure: Nothing to disclose.

Medical Editor

Neil Shear, MD, Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada
Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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