Frostbite: Treatment for Mild to 1st-Degree Symptoms

Frostbite is a rare but serious injury that occurs when the body’s tissues are exposed to cold temperatures. Frostbite can happen when you spend time outdoors when the temperature is below freezing. It can also happen if you are exposed to strong wind. 

Frostbite most commonly occurs in the face and extremities. Signs of frostbite include a loss of feeling and color in the skin. If left untreated, frostbite can lead to permanent damage and even the need for amputation. Frostbite affects people who live outside due to homelessness, work certain jobs, and participate in outdoor recreation.

This article will provide an overview of frostbite including the warning signs, how to treat it, and how to prevent it. 

Frostbite Temperature: How Cold Until Symptoms Begin?

Frostbite can occur in very cold temperatures or if there are strong winds. It is possible to develop frostbite at any temperature below freezing. The colder the weather and the stronger the wind, the higher the risk of frostbite. 

When spending time outdoors in the winter, check the windchill. This number takes into account both the temperature and the strength of the wind to determine how severe the cold is for your body. In a windchill of minus 25 degrees F, frostbite can develop within 15 minutes. 

Signs of Frostbite on Different Body Parts

When your body is cold, it works hard to maintain an optimal core temperature. To do this, the body shifts blood from the extremities to the heart, lungs, and other vital organs. When the extremities like the fingers and toes do not have adequate blood flow, they can quickly become too cold. It is even possible for ice crystals to form in the cells. This leads to serious tissue damage and permanent changes. 

The areas of the body often affected by frostbite include:

• Ears
• Nose
• Cheeks
• Fingers
• Toes

There are several possible signs of frostbite to watch for when spending time in cold weather. These include numbness and skin changes. At first, your skin may appear very red and feel painful. You may also notice that part of your body feels frozen to the touch. Over time, the skin may appear white or gray. It may feel especially firm and waxy as well. Superficial frostbite affects only the skin, and deep frostbite affects both the skin and the underlying tissues. 

Immediate Steps to Take for Suspected Frostbite

As soon as you suspect that you are experiencing frostbite, take immediate action. The goal is to safely warm your skin as fast as possible in order to prevent permanent tissue damage. 

Immediate steps to take to treat frostbite include:

• Go indoors to a warm space.
• Call for medical assistance.
• Rest as soon as you can (never walk on frostbitten feet).
• Remove wet or restrictive clothing.

To warm your skin, place any frostbitten body parts in warm (not hot) water for about 30 to 45 minutes. Do not rub or massage the area because this could cause more damage. It is also important to avoid any sources of dry heat like a heating pad, fireplace, or blow dryer. Because frostbitten skin is often numb, you may burn your skin without realizing it. 

While you warm your skin in water, you may notice swelling and color changes. The skin may feel quite painful during this time. If you develop any blisters, do not try to pop them. Instead, cover them with a sterile dressing or clean cloth until you can seek medical attention. 

Frostbite Treatment Without Amputation

Contact your healthcare provider if you believe you've experienced frostbite. Frostbite treatment options may include:

• Rewarming: Your healthcare provider will start by rewarming the frostbitten areas with warm water. 
• Wound care: Frostbite can cause blisters on the skin. Your healthcare provider will treat, clean, and cover the blisters. Do not pop them on your own. 
• Pain management: Rewarming frostbitten skin can be very painful. Your healthcare provider may recommend taking Tylenol (acetaminophen), Advil (ibuprofen), or other pain medication while your skin warms. 
• Debridement: If there are any signs of infection or gangrene on your frostbitten skin, your healthcare provider may recommend cleaning out the wound with debridement (removing damaged skin). 
• Surgery: In rare cases, frostbite can lead to compartment syndrome, when pressure in the muscles reaches dangerous levels. If this occurs, your healthcare provider will recommend surgically relieving the pressure with an urgent fasciotomy (small incisions made in the heel). 
• Vasodilators: Aurlumyn (iloprost) is an intravenous vasodilator that opens blood vessels and prevents blood from clotting.

Frostbite Treatment With Amputation

In rare cases, frostbite can become so severe that amputation is needed. When frostbite causes severe injury to the tissue, it becomes nonviable and needs to be removed. 

Risk factors for frostbite that is severe enough to require amputation include:

• Grade 4 frostbite
• Delay in seeking care
• Higher altitudes 
• Severely cold temperatures 
  

Healing Frostbitten Skin

In most cases, it is possible to heal frostbitten skin. The first step is usually to rewarm the skin in warm water for about 15 minutes to one hour. During this time, the skin usually turns red or purple and may feel painful. 

Positive signs that your skin is healing include:

• The skin feels warm to the touch after rewarming
• Normal sensation
• Rewarming feels painful
• The skin is pink
• The blisters contain clear liquid (rather than blood)

It is crucial to seek medical attention if you have developed frostbite. Possible complications of untreated frostbite include:

• Tissue swelling
• Tissue death (necrosis)
• Gangrene infection
• Compartment syndrome 
• Joint damage
  

Skin Protection in Extreme Cold Weather

Frostbite is a serious injury that can lead to permanent tissue damage. Fortunately, it is preventable in many cases. To lower your risk of frostbite, take the following steps when spending time in cold weather:

• Protect your skin: Dress for cold weather with loose, light layers of clothing. It is important to stay warm while allowing for ventilation to prevent sweating and trapping moisture on the skin. 
• Cover your head and extremities: Take special care to cover the areas of the body most at risk of frostbite including your head, hands, and feet. Wear thick, wool socks, and opt for mittens over gloves. 
• Stay dry: Wet skin is more at risk of frostbite than dry skin. Try to keep snow out of your boots and clothes. If you become wet, go indoors to warm up and dry off right away.
• Drink water: Staying hydrated is an important way to reduce your risk of frostbite. Drink plenty of water before, during, and after spending time in the cold. 
• Avoid alcohol and nicotine: Refrain from smoking or drinking alcohol in cold weather. 
• Check your skin: Plan to check your skin for any signs of frostbite every 30 minutes. If you notice your extremities becoming numb or changing color, go indoors. 
  

Summary

Frostbite is a rare but serious injury that occurs when the body’s tissues are exposed to cold temperatures. It can happen when spending time outdoors in the cold or windy weather. Any time you are exposed to temperatures below freezing, you are at risk of frostbite. 

Symptoms of frostbite include numbness, a change in color, and waxy skin. As soon as you realize that you may be experiencing frostbite, it is crucial to go indoors and warm up. Remove any wet clothes, and place your frostbitten skin in warm (not hot) water.  Severe frostbite may require medical treatment. Your healthcare provider can provide wound care, pain management, medication to reduce the risk of amputation, and surgery if needed.