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, bone scan or magnetic resonance imaging (MRI) test, to determine the severity of the frostbite and to check if bone or muscle is damaged. Your doctor may also run tests if he or she suspects you have hypothermia, a condition that often occurs with frostbite.
Treatment for frostbite includes first-aid care and medical treatment, depending on the severity of the frostbite. You can treat very mild frostbite (frostnip) with first-aid measures. All other frostbite requires medical attention.
- Check for hypothermia. Get emergency medical help if you suspect hypothermia.
- Protect your skin from further exposure. If you're outside, warm frostbitten hands by tucking them into your armpits. Protect your face, nose and ears by covering them with dry, gloved hands. Don't rub the affected area and never rub snow on frostbitten skin.
- Get out of the cold. Once you're indoors, remove wet clothes.
Gently rewarm frostbitten areas. Soak hands or feet in warm water — 99 to 108 F (37 to 42 C) — for 15 to 30 minutes. If a thermometer isn't available, test the water by placing an uninjured hand or elbow in it — it should feel very warm, not hot.
Don't rewarm frostbitten skin with direct heat, such as a stove, heat lamp, fireplace or heating pad. These can cause burns.
- If there's any chance the affected areas will freeze again, don't thaw them. If they're already thawed, wrap them up so that they don't refreeze.
- Take pain medicine. If you are in pain, take over-the-counter ibuprofen (Advil, Motrin IB, others) to reduce pain and inflammation.
- Don't walk on frostbitten feet or toes if possible. This further damages the tissue.
- Know what to expect as skin thaws. If the skin turns red and you feel tingling and burning as it warms, normal blood flow is returning. But seek emergency medical attention if the numbness or pain remains during warming or if blisters develop.
- 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. You may need a brace or splint if the bone or muscle is involved. 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. Soaking in a whirlpool bath (hydrotherapy) can aid healing by keeping skin clean and naturally removing dead tissue. You'll be encouraged to gently move the affected area while it is under water.
- 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 therapy. If you have a complex wound, your doctor might suggest a technique called vacuum-assisted closure therapy to promote healing.
- Surgery. In severe cases, surgery or amputation may be necessary to remove the 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, apply aloe vera gel or lotion to the affected area several times a day to reduce inflammation.
- Avoid further exposure to cold and wind.
- 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 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.
What you can do in the meantime
While you wait for your appointment, take appropriate self-care measures, such as:
- Protecting the affected area from further cold
- Not walking on frostbitten feet
- Reducing pain with ibuprofen (Advil, Motrin IB, others)
- Not breaking blisters that may develop
March 09, 2018
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