Frostbite is injury to the skin and other tissues that results from prolonged
exposure to cold. It can occur with exposure to below-freezing temperatures for
several hours, or to above-freezing temperatures if there is a strong wind or if
the person is at high altitude or wet. Frostbite usually affects the hands,
feet, nose, cheeks, and ears; it can also affect the genitals in males.
Superficial frostbite injures the skin and tissues just beneath it. It typically
resolves in 3 to 4 weeks. Deep frostbite, which also affects muscle, nerves, and
blood vessels, may result in tissue death, a condition known as gangrene.
Signs and Symptoms
The following are signs and symptoms of frostbite:
Pain progressing to numbness
White color and waxy appearance of the skin of affected
Blood rushing to area after it's rewarmed
Burning sensation and swelling from collected fluid that may last for
Black scab-like crust, which may develop several weeks
What Causes It?
When exposed to cold conditions, the body tries to preserve heat. To do this,
blood vessels near the skin's surface constrict, forcing more blood into the
core. This helps prevent hypothermia, a lowering of the body's core temperature
below 93°F (34°C). However, it also prevents the extremities from receiving
enough blood, allowing them to become cold. At first, the blood vessels
alternate between constricting and dilating, to keep the extremities as warm as
possible. But under extremely cold conditions, the vessels stop dilating, as
core temperature becomes the priority. When skin temperature drops low enough,
ice crystals can form around and within the cells, robbing cells of needed water
and possibly causing cell death.
Who's Most At Risk?
These factors increase the risk for frostbite:
Intoxication with alcohol or other substances
Very young or very old age
Peripheral vascular disease (narrowing of blood vessels in
Exhaustion, hunger, malnutrition, or dehydration
Winter sports, especially at high altitudes
What to Expect at Your Provider's Office
Your healthcare provider will ask about your exposure to cold, including what
the temperature was and how long you were exposed. He or she will also examine
your skin, looking for signs of superficial and deep injury, the extent of which
may not become apparent until the area rewarms. Blood tests and imaging studies,
such as magnetic resonance imaging (MRI), may be needed to determine the
severity of your injury as well as any complications, such as
Take these steps to help prevent frostbite:
Wear several layers of warm clothing that do not constrict movement
and that provide protection from wind and water.
Wear dry, warm gloves, socks, and insulated boots.
Cover your head, preferably with earflaps in extreme conditions.
Thirty percent of heat loss occurs through the head.
Drink plenty of fluids and eat plenty of food during lengthy outings.
Do not drink alcohol.
Watch for the development of white patches on the face and ears of
your companions. These may signal
It's important to get conventional medical care as soon as possible for
frostbite. Mild frostbite is treated by rewarming the affected area, washing it
with an antiseptic, applying a sterile dressing, taking daily whirlpool baths,
and resting in bed. If medical care is not available immediately, rewarm a
mildly frostbitten area in a bath of warm water. It's important not to use hot
water, fire, a household heater, or the like (unless warm water is not
available) because these methods may burn the skin before the feeling returns.
Remove any jewelry from the affected area before rewarming because the area may
swell. Never rub or massage frozen body parts, and avoid walking on a
frostbitten foot if possible.
Deep frostbite is treated by rapid thawing (only if there is no danger of
refreezing) in a warm water bath. The patient should be hospitalized and have
the frostbitten area elevated. Medication may be given to control pain.
Healthcare providers will take steps to prevent or treat any infection.
Twice-daily warm whirlpool baths with an aseptic solution are used until healing
has occurred, which may take weeks to months. Cotton is often placed between
affected toes or fingers to separate them and help them heal. Deep frostbite is
often accompanied by hypothermia, a medical emergency that requires hospital
Your provider may prescribe drugs, such as narcotic analgesics to treat pain,
nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation,
antibiotics to prevent or treat infection, or tetanus toxoid to prevent
If frostbite has caused tissue death in any area, such as a hand or foot, the
extremity or area may require amputation. Typically this decision is not made
for several months, when the extent of the damage is more evident. (At first,
frostbite may look worse than it is because the skin may be more seriously
affected than the underlying tissues.) If, however, the person has serious
infection, wet gangrene, or pain that won't respond to treatment, surgery may be
required sooner. Some healthcare providers use a
sympathectomy—surgery to remove a section of
nerves—to decrease severe swelling, help save tissue,
and forestall complications. Long-term benefits of this surgery have not been
Complementary and Alternative Therapies
As stated, it is important to seek conventional care for frostbite as soon as
possible to prevent serious tissue damage. While nutritional supplements may
enhance conventional treatment, drinking fluids and eating plenty of food before
and during exposure to cold remain the key to avoiding and treating frostbite
because they help maintain the body's core temperature.
In a well-designed, controlled animal study, rats with frostbite were given
oral vitamin C together with either a warm water bath (as used in conventional
care) or a warm bath containing Indian black tea. Each of these groups did
better than the rats that received only standard care (namely, a warm water bath
alone), suggesting that vitamin C may be a good addition to standard, medical
treatment of frostbite. In addition, the group that received oral vitamin C in
combination with the Indian black tea baths did the best of the three. The
ingredients in the black tea that may have contributed to the additional
improvement are as follows:
Theophylline - may enhance one's ability to
generate body heat
When taken prior to cold exposure, the following fat-soluble antioxidants may
help protect against development of frostbite or other cold-induced
Cayanne pepper (Capsicum spp) in topical form has long been
used traditionally in China and Japan to treat frostbite.
Poplar buds (Populus spp. including P. nigra, P.
canadensis, and P. tachamahaca), also known as balm of Gilead and
balm of Mecca, may be used in mild cases of frostbite as an ointment or other
topical formula (containing 20% to 30% bud exudate) to alleviate the pain and
reduce the risk of infection associated with frostbite.
There have been few studies examining the effectiveness of specific
homeopathic remedies. A professional homeopath, however, may recommend one or
more of the following treatments for frostbite based on his or her knowledge and
clinical experience. Before prescribing a remedy, homeopaths take into account a
person's constitutional type. In homeopathic terms, a person's constitution is
his or her physical, emotional, and intellectual makeup. An experienced
homeopath assesses all of these factors when determining the most appropriate
remedy for a particular individual.
Agaricus — primary remedy for the
burning, itching, redness, and swelling associated with frostbite
Apismellifica — for the
burning or stinging sensation and redness associated with frostbite,
particularly if there is excessive swelling; individuals who benefit from this
remedy may also have a dull pain the back of the head
Carbo vegetabilis — for individuals
who feel faint or who have difficulty breathing
Lachesis — for frostbite with a blue
or purple discoloration; the skin may bleed easily and irreversible tissue
damage may result if it is not treated; this remedy is most appropriate for
individuals who are restless and unsettled
Silicea — for frostbite in thin, frail
people who typically feel cold and tired; this remedy is most appropriate for
individuals who have pus-filled wounds
Frostbitten areas should never be massaged or vigorously rubbed.
The outlook for frostbite depends on the depth of tissue injury and can range
from complete recovery to amputation.
Possible complications of frostbite include the following:
Increased sensitivity to cold
Changed skin color
Faulty nail growth in an affected hand or foot
Pain with use of the affected area
Altered sensation in the affected area
Because the damage caused by frostbite is not always immediately evident,
healthcare providers will want to monitor your condition over weeks or even
months to determine the severity of the injury.
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Review Date: December 2000
Reviewed By: Participants in the review process include: Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA.
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