Rosalyn Carson-DeWitt, MD
Frostbite is damage to skin and tissues from prolonged exposure to below-freezing temperatures. Frostbite severity is based on the depth of tissue injury. The most severe frostbite can lead to permanent damage and/or amputation.
The most common parts of the body to become frostbitten include your fingers, toes, ears, nose, chin, or cheeks.
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Exposure to below-freezing temperatures can cause the body tissue to freeze. Ice crystals form within the frozen body part. Blood cannot flow through the frozen tissue. This causes the frozen tissue to be deprived of blood and oxygen. The combination of freezing and oxygen deprivation causes tissue damage or tissue death. Some tissue damage may also happen during warming.
Factors that may increase your chance of frostbite include:
Exposure to below-freezing temperatures without adequate covering
Low body temperature—
hypothermia Being very young or very old
History of previous cold weather injury
High-altitude cold exposure
Working in below-freezing conditions
Participating in winter sports or high-altitude sports
Wearing wet clothing
Suffering from a condition that affects your mental status such as:
Head injury Mental illness Use of mind-altering drugs or
alcohol Inability to move
Using drugs that cause your blood vessels to become constricted
Medical conditions, such as:
Malnutrition Thyroid problems Infection Disease of the blood vessels Arthritis Diabetes Raynaud's phenomenon
Early stages of frostbite may cause:
Weakness or clumsiness with extremities, such as with your hands or feet
Numbness, stinging, burning, or tingling sensation
Areas of white skin blended with or next to healthy-looking skin
Coldness or firmness of tissue
Pain, especially during the thawing process
Inflammation may occur during the thawing process
Later stages of frostbite may cause:
Waxy appearance of the skin
Color ranging from white to blue, depending on severity
Blisters that may be filled with clear or bloody fluid, usually during rewarming
You will be asked about your symptoms and medical history. A physical exam will be done. Diagnosis is usually based on symptoms and the findings of the physical exam.
Rapid rewarming in a warm (98.60°F to 102.2°F [37°C to 39°C]) water bath is the treatment of choice. Slow rewarming may cause more tissue damage.
If you are stranded with frostbite and unable to get medical help:
Try to get to a warm location. Wrap yourself in blankets.
Do not put snow or hot water on the injured area.
Do not rub affected areas.
Tuck your hands into your armpits to try to rewarm them.
If it's available, use warm water (at about 100°F [38°C]) to rewarm your frostbitten area.
Avoid refreezing the affected area. This can result in more severe injury.
Walking on frozen feet and toes can cause damage. It may be more important to find shelter.
Drink warm liquids.
Avoid alcohol and sedatives.
Cover the injured area with a clean cloth until you can get medical help.
Rewarming can be intensely painful. To relieve pain, take an over-the-counter pain medication such as acetaminophen or ibuprofen.
Medications used depend on the severity of frostbite. Examples include:
Antibiotics to treat any bacterial infections
anti-inflammatory drugs (NSAIDs) to reduce inflammation
Prescription pain medication
Drugs to prevent blood clots in the first 24 hours
Vasodilators after 24 hours if needed due to lack of improvement
Other frostbite treatments may include:
Opening and emptying blisters
Aloe vera gel or other ointments to relieve inflammation and promote healing
Elevation of the injured body part above your heart
tetanus booster shot
Hyperbaric oxygen therapy
—a special chamber that uses oxygen under greater pressure than normal to help with blood flow and tissue repair
Surgery—in severe cases, amputation of all or part of the affected body part may be necessary
To help reduce the chance of frostbite:
Dress properly when going outside in cold weather:
Cover your head, face, hands, and feet adequately. Wear layers of clothing. Wear materials that provide good insulation, such as wool, polyester, or polypropylene. It should keep moisture away from the skin. Wear a waterproof outer layer and stay dry. Avoid drinking alcohol when you will be in cold weather.
Stay hydrated by drinking water.
Recognize signs of early frostbite, such as numbness, paleness, and difficulty grasping objects with your hands.
Treat early frostbite promptly with the body heat of a companion by using their abdomen or armpit for warmth.
Family Doctor—American Academy of Family Physicians
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org CANADIAN RESOURCES:
Canadian Dermatology Association
Environment and Climate Change Canada
Frostbite. Centers for Disease Control and Prevention website. Available at:
https://www.cdc.gov/disasters/winter/staysafe/frostbite.html. Updated December 20, 2016. Accessed August 18, 2017.
Frostbite. EBSCO DynaMed Plus website. Available at:
. Updated December 2, 2016. Accessed August 18, 2017.
Frostbite. Kids Health—Nemours Foundation website. Available at:
...(Click grey area to select URL) Updated January 2015. Accessed September August 18, 2017.
Last reviewed September 2018 by
EBSCO Medical Review Board
Michael Woods, MD, FAAP Last Updated: 9/25/2014