Frostbite

Definition

Frostbite is damage to the skin and underlying tissues caused by extreme cold.

Alternative Names

Cold exposure - arms or legs

Considerations

A person with frostbite on the extremities may also be subject to hypothermia (lowered body temperature). Check for hypothermia and treat those symptoms first.

Frostbite is distinguishable by the hard, pale, and cold quality of skin that has been exposed to the cold for too long. The area is likely to lack sensitivity to touch, although there may be an aching pain. As the area thaws, the flesh becomes red and very painful.

Any part of the body may be affected by frostbite; but hands, feet, nose and ears are the most vulnerable. If only the skin and underlying tissues are damaged, recovery may be complete. However, if blood vessels are affected, the damage is permanent and gangrene can follow. This may require removal (amputation) of the affected part.

Upon warming, it is common to experience intense pain and tingling or burning in the affected area.

Causes

Frostbite occurs when the skin and body tissues are exposed to cold temperature for a prolonged period of time. Hands, feet, noses, and ears are most likely to be affected.

Although anyone who is exposed to freezing cold for a prolonged period of time can get frostbite, people who are taking beta-blockers, which decrease the flow of blood to the skin, are particularly susceptible. So are people with peripheral vascular disease (a disorder of the arteries). Other things that may increase the risk of frostbite include: smoking, windy weather (which increases the rate of heat loss from skin), diabetes, peripheral neuropathy, and Raynaud's phenomenon.

References

Ulrich AS. Hypothermia and localized cold injuries. Emerg Med Clin North Am. 2004; 22(2): 281-98.

Petrone P. Surgical management and strategies in the treatment of hypothermia and cold injury. Emerg Med Clin North Am. 2003; 21(4): 1165-78.

Morton PM. Wilderness survival. Emerg Med Clin North Am. 204; 22(2): 475-509, ix-x.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo: Mosby; 2006.