What are the other Names for this Condition? (Also known as/Synonyms)

• Permanent Cold Injury

What is Frostbite? (Definition/Background Information)

• Frostbite is a severe form of cold injury occurring to peripheral parts of the body, such as the hands and feet (fingers and toes), after exposure to freezing temperatures/conditions. It leads to serious tissue injury causing necrosis, which is permanent and irreversible
• Based on the extent of tissue injury, Frostbite can be subdivided into 4 categories:
  • 1st degree Frostbite: There is superficial damage to the skin and subcutaneous layers. The affected region may be numb, pale yellow to white in color, and may show some swelling due to fluid accumulation (edema)
  • 2nd degree Frostbite: In addition to findings of 1st degree Frostbite, skin blisters filled with clear or milky fluid may be noted
  • 3rd degree Frostbite: In this condition, in addition to symptoms of both first and second degree Frostbite, the blisters are usually blood-filled (hemorrhage. Deeper layers underneath the skin are also damaged
  • 4th degree Frostbite: There is extensive damage to underlying structures such as the muscle, tendons, and bones. In 1-2 weeks, the affected tissue becomes necrotic and the skin overlying the affected region turns dry, dark tan to black in color
• The complications of Frostbite may include tetanus infection, gangrene, loss of a digi(s)t or limb, and recurrence of the condition. Young children and older adults may be more severely affected by Frostbite
• In order to prevent severe and further Frostbite injury, the individual has to be immediately removed from the area of cold exposure; wet clothing, if any, should be removed and prompt treatment administered
• The treatment measures for Frostbite may include slowly rewarming the affected region to regulate blood flow, adequate hydration by oral or intravenous fluids, and hospitalization
• The prognosis of Frostbite is based on the severity and duration of exposure to freezing temperatures, the level of injury sustained, and speedy treatment provided. Typically, individuals with mild exposure to cold have better prognosis than those with severe exposure and injury from cold

Who gets Frostbite? (Age and Sex Distribution)

• Frostbite may be observed in individuals of all age groups including children and adults
• Both males and females are affected, and no gender preference is noted
• No racial or ethnic group predilection is observed and the condition is observed worldwide, in the cold regions

What are the Risk Factors for Frostbite? (Predisposing Factors)

The risk factors for Frostbite may include:

• Prolonged unprotected exposure to freezing weather/temperatures
• Living or travelling in cold regions without adequate protective clothing
• Older adults and very young children have an elevated risk for this form of cold injury. Generally, children have a higher risk of cold injury due to quicker heat loss from the body
• Drug-abuse and smoking
• Previous history of Frostbite
• Residing or visiting high altitudes
• Alcohol consumption
• Having low body weight
• Uncontrolled diabetes
• Anorexia nervosa
• Raynaud’s disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Frostbite? (Etiology)

• When extremely cold freezing temperatures cause local areas of skin and underlying tissues to freeze, it is termed as Frostbite. This usually involves the face, hands, and feet
• Frostbite occurs by freezing temperatures including direct contact with ice and freezing objects. The injuries may be mild (involving the superficial skin alone) or severe (involving the skin and deeper tissues), depending on the degree level and duration of exposure to cold
• Based on the extent of injury, the condition can lead to irreversible and permanent skin and tissue damage, even after slowly rewarming the area

What are the Signs and Symptoms of Frostbite?

The signs and symptoms of Frostbite may include:

• Changing of skin color to white or grayish yellow
• The skin is very cold, numb, and hard to touch
• Itching and burning sensation may be noted
• Hard, firm, and waxy skin
• Blistering
• Hands, feet, ears, and nose are typically affected by Frostbite

In case of severe Frostbite, the following signs and symptoms may be observed:

• Symptoms of hypothermia including blurring of speech, uncontrolled shivering, sleepiness or drowsiness, and loss of coordination
• Infections
• Permanent nerve damage

How is Frostbite Diagnosed?

Frostbite may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests such as:
  • Complete blood count (CBC)
  • Serum electrolyte levels
  • Blood gas analysis
  • Blood glucose levels
  • Serum protein electrophoresis
• Radiological imaging studies to determine the extent of tissue damage
• Skin biopsy, if necessary: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

In many cases, no skin biopsy is necessary and the condition may be diagnosed via the presenting symptoms by a healthcare provider.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Frostbite?

The following complications of Frostbite may be observed:

• Cosmetic issues resulting in emotional stress
• Secondary bacterial and fungal infection due to scratching, bleeding, and ulceration
• Increased risk of Frostbite in future
• Tetanus infection
• Tissue gangrene
• Growths defect in children, if the growth plates are damaged
• Loss of limb or affected part

How is Frostbite Treated?

The following treatment measures may be considered for Frostbite:

• Gradually rewarming the affected region, to the extent possible
• Maintaining hydration through oral and intravenous fluids
• Oxygen therapy, if needed
• Amputation of the affected part, if tissue conservation cannot be maintained
• Tetanus booster shots
• Administration of antibiotics to prevent secondary infections
• Often, hospitalization is necessary to treat the condition

How can Frostbite be Prevented?

Avoiding exposure to cold weather and cold temperatures can help prevent Frostbite. Additionally, the following steps may be taken to prevent the condition:

• Plan sufficiently in advance for cold conditions
• Avoid exposure to extremely cold weathers; ensure adequate warm clothing for vulnerable people, especially the very young and the very old
• Dress in layers, during extreme cold weathers; wear appropriate gloves
• Keep your hands and feet dry, in cold weather conditions
• Avoid tight fitting clothing or footwear that can compromise blood flow
• Individuals with occupational risks should take sufficient precautions/protection (warm clothing, use of mittens, etc.)
• Avoiding alcohol and smoking
• Avoid dehydration; keep yourself adequately hydrated
• Keep health conditions, such as diabetes, under control

What is the Prognosis of Frostbite? (Outcomes/Resolutions)

The prognosis of Frostbite depends on the severity of exposure to cold and the extent of injury it causes.

• In many individuals, with early attention and prompt treatment, the prognosis may be good
• However, prolonged unprotected exposure to freezing temperatures can cause irreversible tissue damage. In such cases, the prognosis may be unpredictable

Additional and Relevant Useful Information for Frostbite:

The following is a useful resource for additional information on First Aid for Frostbite:

https://www.dovemed.com/healthy-living/first-aid/frostbite-first-aid/