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Medical Author:

Steven Doerr, MD

Steven Doerr, MD

Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• Frostbite and Cold Weather-Related Injuries Facts
• Introduction to frostbite and cold weather-related injuries
• What type of injuries can be caused by cold weather?
• Cold weather-related injuries without tissue freezing
• Chilblains
• Trench foot
• Frostnip
• Cold weather-related injuries with tissue freezing
• Frostbite
• What does frostbite look like (frostbite pictures)?
• What are the signs and symptoms of frostbite?
• How should frostbite and other cold weather-related injuries be treated?
• What is the recovery time for a frostbite injury?
• When should a person seek medical care for a cold weather-related injury?
• Who is most likely to get a cold weather-related injury and what can be done to prevent it?
• Patient Comments: Frostbite - Experience
• Frostbite Index

Frostnip is a mild cold weather-related injury that typically affects the face, ears, toes, and fingers. After exposure to cold weather, the affected area may appear pale, and may be accompanied by burning, itching or pain. Tingling or numbness are frequently present. Simple re-warming restores normal color and sensation, and there is no subsequent permanent tissue damage.

Frostbite occurs when there is freezing of body tissue, and it is the most serious of the cold weather-related injuries. Frostbite usually affects the hands, feet, nose, ears, and cheeks, though other areas of the body may also be affected. This type of injury results from decreased blood flow and heat delivery to body tissues resulting in damaging ice crystal formation, which ultimately leads to cell death. Upon re-warming of the affected tissue, vascular damage and complex cellular metabolic abnormalities lead to tissue death. Damage to tissue is most pronounced when there is prolonged cold weather exposure, the affected area slowly freezes, and the subsequent re-warming process is slow. Repeated thawing and refreezing of the affected tissue is particularly damaging, and should be avoided.

Frostbite injuries can be classified as either superficial or deep, depending on the tissue depth of injury. Superficial frostbite injuries involve the skin and subcutaneous tissues, while deep frostbite injuries extend beyond the subcutaneous tissues and involve the tendons, muscles, nerves, and even bone. Superficial frostbite injuries have a better prognosis than deep frostbite injuries.

The signs and symptoms of frostbite depend on the extent and depth of tissue injury. Individuals with superficial frostbite may experience the following signs and symptoms to the affected area:

• pain,
  
  
• burning,
  
  
• tingling,
  
  
• numbness,
  
  
• pale colored skin,
  
  
• clear-colored skin blisters may develop, and
  
  
• firm-feeling skin with soft underlying tissue which can move over bony ridges.

As the degree of injury progresses (1st to 3rd) to involve deeper tissue structures, the signs and symptoms of deep frostbite can develop, which may include the following:

• complete loss of sensation,
  
  
• pale, yellowish, bluish, gray, or mottled skin color,
  
  
• formation of blood-filled skin blisters, and
  
  
• firm-feeling skin and underlying tissue, with the affected area feeling hard and solid.

With advanced frostbite injuries, the affected area can subsequently appear blackened and gangrene can develop, placing the affected individual at high-risk for infection.