eMedicine Specialties > Dermatology > Environmental

Frostbite

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

Introduction

Background

Frostbite is an injury caused by exposure to cold temperatures. The temperature does not necessarily need to be below freezing for this injury to occur. The cold temperatures can cause ice crystals and clots to form and can result in poor perfusion to the face and the extremities, leading to dehydration and cell death. If the exposure continues, damage may occur to underlying blood vessels, nerves, and muscles. When patients receive medical care quickly, frostbite is often reversible because the injury is less severe. If treatment is delayed, patients may have long-term medical problems.

The following are other eMedicine articles on frostbite:

Pathophysiology

The extreme cold temperatures cause ice crystals to form in and around cells. Red blood cells and platelets also start to stick together, causing clots and ischemic damage in the extremities. Damage is also caused by reperfusion as the skin is warmed; therefore, if refreezing is a possibility, not warming the frostbite is important.

Frequency

United States

About 4800 cases of frostbite occur in the United States each year.

Mortality/Morbidity

  • 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 symptoms include paresthesia, sensitivity to cold, and faulty nail growth.

Race

All races are affected equally.

Sex

Both men and women are affected equally.

Age

People of all ages are affected.

  • Elderly persons are more likely to be at risk because of other existing medical problems (eg, poor circulation).
  • Young persons are also at higher risk because they may not be able to move themselves indoors.

Clinical

History

Exposure to cold produces injuries that occur as a result of the human inability to adapt to cold.1 These injuries may be localized, systemic (as in hypothermia), or a combination of both. No serious damage usually occurs until tissue freezes. The mildest form of peripheral cold injury is termed frostnip. Chilblains is a more severe form of cold injury than frostnip and tends to occur after exposure to nonfreezing temperatures and damp conditions. Patients with frostbite often have multisystem injuries such as systemic hypothermia, blunt trauma, and substance abuse.

  • Patients may have a history of prolonged exposure to cold weather. The exposure time and the temperature contribute to the depth of the frostbite and the amount of damage caused by the injury.
  • Patients often have no feeling in the area of skin that is affected by frostbite; therefore, they may complain of paresthesia, numbness, or joint pain.

Physical

  • Tissue that is affected by frostbite appears pale and is cold and hard. Common affected parts include a finger, a toe, an ear, the nose, or a cheek.
  • Later, after warming, the skin becomes erythematous and edematous, and patients experience throbbing pain.
  • The skin can be blue, or it can be necrotic or gangrenous.
  • Within 6 hours, blisters appear and may be filled with clear fluid (indicating superficial damage) or with blood (indicating deep tissue damage).
    • With superficial injuries, only the surface is frozen and deeper tissues are soft.
    • With deep injury, the frozen part is hard and feels solid.
  • Gangrene may appear and consists of 2 forms: wet and dry.
    • Wet gangrene gives the skin a gray appearance and is soft.
    • Dry gangrene gives the skin a black appearance and is hard.

Causes

Frostbite is caused by exposure to cold temperatures. The temperature does not necessarily need to be below freezing for injury to occur.

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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