Frostbite

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Diagnosis

Diagnosing frostbite is based on your symptoms and a review of recent activities during which you were exposed to cold.

Your healthcare team may have you undergo X-rays or an MRI to look for bone or muscle damage. It may take 2 to 4 days after rewarming to tell the extent of tissue damage.

Mayo Clinic Minute: Why the risk of frostbite is greater than you think

Ian Roth: As winter drags on and temperatures drop way down, your risk of cold-related injury like frostbite can go way up.

Sanj Kakar, M.D., Orthopedic Surgery, Mayo Clinic: Literally think of it as freezing of the tissues.

Ian Roth: Dr. Sanj Kakar, a Mayo Clinic Orthopedic hand and wrist surgeon, says frostbite is more common than many people think.

Dr. Kakar: We tend to see frostbite, for example, when the temperature is 5 degrees Fahrenheit with minimal windchill.

Ian Roth: If the windchill drops below negative 15 degrees Fahrenheit, not unheard of in the northern half of the U.S., frostbite can set in within half an hour. The most vulnerable areas of frostbite are your nose, ears, fingers and toes.

Dr. Kakar: Initially [with] the milder forms, you can get some pain and some numbness of the tips, but the skin can change its color. It can be red. It can be white. Or it can be blue. And you can get these blisters on your hands. And it can be a very serious injury.

Ian Roth: The worst cases, the tissue can die, and you may need surgery to remove it.

So who's most at risk?

Dr. Kakar: [Those most at risk are] certain patients with diabetes, patients who have previous history of frostbite are prone to it, the elderly or your very young children, and also, for example, if you're dehydrated.

Ian Roth: For the Mayo Clinic News Network, I'm Ian Roth.

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Treatment

First aid for frostbite is as follows:

  • If you suspect hypothermia, call for emergency help.
  • Protect the injured area from further damage. Do not try to rewarm the frostbitten skin if it might freeze again.
  • Get out of the cold, remove wet clothes and wrap up in a warm blanket.

  • If possible, soak the skin with frostbite in a tub or sink of warm water for about 30 minutes. For frostbite on the nose or ears, cover the area with warm, wet cloths for about 30 minutes.

    Another option is to warm the affected skin with body heat. For example, tuck frostbitten fingers under an armpit.

  • Don't walk on frostbitten feet or toes if possible.
  • Take a nonprescription pain reliever if needed.
  • Drink a warm, nonalcoholic beverage.
  • Remove rings or other tight items. Do this before the injured area swells with rewarming.
  • Don't apply direct heat. For example, don't warm the skin with a heating pad, a heat lamp, a blow-dryer or a car heater.
  • Don't rub the frostbitten skin.

After providing first aid, seek treatment from a healthcare professional if you have frostbite. Treatment may involve rewarming, medicine, wound care, surgery or other steps depending on how serious the injury is.

  • Rewarm the skin. If the skin hasn't been rewarmed already, your healthcare team rewarms the area using a warm-water bath for 15 to 30 minutes. The skin may turn soft. You may be asked to gently move the affected area as it rewarms.
  • Take pain medicine. Because the rewarming process can be painful, you may be given a pain reliever.
  • Protect the injury. Once the skin thaws, your healthcare team may loosely wrap the area with sterile sheets, towels or dressings to protect the skin. You may need to raise the affected area to reduce swelling.
  • Soak in a whirlpool. Soaking in a whirlpool bath can aid healing, as it keeps the skin clean and naturally removes dead tissue.
  • Take infection-fighting drugs. If the skin or blisters look infected, your healthcare team may prescribe antibiotic medicine taken by mouth.

  • Take medicine. You may receive an injection of medicine in a vein that helps restore blood flow. This type of medicine is called a thrombolytic. One example is tissue plasminogen activator, also called TPA. Studies of people with severe frostbite show that TPA may lower the risk of amputation. But this medicine can cause serious bleeding. It's sometimes used in serious situations and within 24 hours of cold exposure.

    Another medicine that improves blood flow is iloprost (Aurlumyn). It was recently approved by the FDA for severe frostbite in adults. It can reduce the risk of finger or toe amputation. Side effects of this medicine include headache, flushing and heart palpitations.

  • Remove damaged tissue. To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. This procedure to remove this tissue is called debridement.
  • Tend to blisters and wounds. Blisters can act as a natural dressing. Depending on the type of blisters, your healthcare team may leave them to heal on their own or drain them. A variety of wound care techniques may be used depending on the extent of injury.
  • Undergo surgery. People who have experienced severe frostbite may in time need surgery or amputation to remove dead or decaying tissue.

More Information

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Lifestyle and home remedies

After rewarming, your skin may stop tingling and return to its usual color within a few hours. Deep tissue injury may heal slowly and be very sensitive to the touch for weeks. Take all medicines as prescribed by your healthcare team. For mild frostbite, a nonprescription pain reliever can help ease symptoms.

Preparing for your appointment

Seek medical care if you suspect you have frostbite. For serious frostbite, you may be told to go to an emergency room.

If you have time before your appointment, use the information below to get ready.

What you can do

  • List any symptoms you have and how long you've had them. It helps your healthcare team to have as many details as possible about your cold exposure and to know if your symptoms have changed.
  • List your key medical information, including any other conditions with which you've been diagnosed. Also list all medicines you're taking, including nonprescription medicines and supplements.
  • Make a note of the date of your last tetanus shot. Frostbite increases the risk of tetanus. If you haven't had a tetanus shot or haven't had one within five years, your healthcare team may recommend that you get a shot.
  • List questions to ask your healthcare team. Being prepared helps you make the most of the time you have with your healthcare team.

For frostbite, some basic questions to ask your healthcare team include:

  • Are tests needed to confirm the diagnosis?
  • What are my treatment options and the pros and cons for each?
  • What results can I expect?
  • What skin care routines do you recommend while the frostbite heals?
  • What kind of follow-up, if any, should I expect?
  • What changes in my skin should I look for?

Don't hesitate to ask any other questions that occur to you.

By Mayo Clinic Staff
Request an appointment
Symptoms & causes
March 26, 2024
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  19. FDA approves first medication to treat severe frostbite (news release). U.S. Food and Drug Administration. https://www.fda.gov. Accessed Feb. 14, 2024.

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