Diagnosis

The diagnosis of frostbite is usually made based on your signs and symptoms, the appearance of your skin, and a review of recent activities in which you were exposed to cold.

Your doctor may conduct tests, such as an X-ray, a bone scan or an MRI. These can help him or her determine the severity of your frostbite and check whether bone or muscle is damaged.

Treatment

Minor frostbite can be treated at home with basic first-aid measures. For all other frostbite, after appropriate first aid and assessment for hypothermia, treatment may involve rewarming, medications, wound care, surgery and various therapies, depending on the severity of your injury.

  • Rewarming of the skin. If it hasn't been done already, your doctor will rewarm the area using a warm-water bath for 15 to 30 minutes. The skin may turn soft and look red or purple. You may be encouraged to gently move the affected area as it rewarms.
  • Oral pain medicine. Because the rewarming process can be painful, your doctor will likely give you a drug to ease the pain.
  • Protecting the injury. Once your skin thaws, your doctor may loosely wrap the area with sterile sheets, towels or dressings to protect the skin. Or he or she may protect your fingers or toes as they thaw by gently separating them from each other. And you may need to elevate the affected area to reduce swelling.
  • Removal of damaged tissue (debridement). To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. To better distinguish between healthy and dead tissue, your doctor may wait one to three months before removing damaged tissue.
  • Whirlpool therapy or physical therapy. Soaking in a whirlpool bath (hydrotherapy) can aid healing by keeping skin clean and naturally removing dead tissue. You may be encouraged to gently move the affected area.
  • Infection-fighting drugs. If your skin or blisters appear infected, your doctor may prescribe oral antibiotics.
  • Clot-busting drugs. You may receive an intravenous injection (IV) of a drug that helps restore blood flow (thrombolytic), such as tissue plasminogen activator (TPA). Studies of people with severe frostbite show that TPA lowers the risk of amputation. But these drugs can cause serious bleeding and are typically used only in the most serious situations and within 24 hours of exposure.
  • Wound care. A variety of wound care techniques may be used, depending on the extent of injury.
  • Surgery. People who have experienced severe frostbite may in time need surgery or amputation to remove dead or decaying tissue.
  • Hyperbaric oxygen therapy. Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room. Some patients showed improved symptoms after this therapy. But more study is needed.

Lifestyle and home remedies

To care for your skin after frostbite:

  • Take all medications — antibiotics or pain medicine — as prescribed by your doctor. For milder cases of frostbite, take over-the-counter ibuprofen (Advil, Motrin IB, others) to reduce pain and inflammation.
  • For superficial frostbite that has been rewarmed, some people find it soothing to apply aloe vera gel or lotion to the affected area several times a day.
  • Avoid further exposure to cold and wind.
  • Remove rings or other tight items. Try to do this before the affected area swells.
  • Don't walk on frostbitten feet.
  • Don't apply direct heat or rub the area.
  • Don't break blisters that may develop. Blisters act like a bandage. Allow blisters to break on their own.

Preparing for your appointment

Call your doctor if you suspect you have frostbite or hypothermia. Depending on the severity of your symptoms, you may be told to go to an emergency room.

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

What you can do

  • List any signs and symptoms you're experiencing and for how long. It will help your doctor to have as many details as possible about your cold exposure and to know if your signs and symptoms have changed or progressed.
  • List your key medical information, including any other conditions with which you've been diagnosed. Also list all medications you're taking, including over-the-counter medications and supplements.
  • Make a note of the date of your last tetanus shot. Frostbite increases the risk of tetanus. If you haven't been vaccinated or if your last shot was more than 10 years ago, your doctor may recommend that you be vaccinated.
  • List questions to ask your doctor. Being prepared will help you make the most of the time you have with your doctor.

For frostbite, some basic questions to ask your doctor 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.

Sept. 12, 2018
References
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  4. Frostbite. Centers for Disease Control and Prevention. https://www.cdc.gov/disasters/winter/staysafe/frostbite.html. Accessed July 13, 2018.
  5. Walls RM, et al., eds. Frostbite and nonfreezing cold injuries. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed July 13, 2018.
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  8. Miller T. Preparing for cold weather exercise. Performance Training Journal. 2010;3:1.