Overview
When the temperature plummets, being outdoors for even a few minutes without proper protection from the elements can put you at risk for developing frostbite. While frostbite is typically a treatable condition, in severe cases, it may result in amputation.
Frostbite means the skin—and sometimes the tissues underneath the skin—freezes. That’s because 64% of skin consists of water. Just like water turns to ice in freezing temperatures, ice crystals can form inside the cells of skin exposed to cold temperatures for extended periods of time if not properly covered.
Circulation issues can increase the risk of frostbite, which usually occurs in peripheral areas of the body located farther from the heart. (To help preserve warmth in the body’s core, where the major organs are located, the vascular system will decrease blood flow [vasoconstriction] to the extremities in extreme cold.)
“Infants and young children are particularly at risk because they can’t always communicate their symptoms and lose heat from the skin more readily,” says Sara Perkins, MD, a Yale Medicine dermatologist.
People of all ages should be on alert for frostbite, though. “Temperature changes, moisture, and underlying health conditions can all influence the risk for developing frostbite,” she adds.
What are the symptoms of frostbite?
- Redness
- Stinging or burning sensation
- Numbness
- Throbbing
- Aching
- Prickly, pins-and-needles feeling
- Pale, yellow, or bluish areas on the skin
- Blackened areas of skin (gangrene)
- Thick, hardened skin
What increases the risk of frostbite?
Prolonged periods spent outdoors in very cold temperatures, as well as wet and/or windy conditions, can lead to frostbite. Below are other things you should be aware of that decrease blood flow, which can increase your risk:
- Health conditions that cause poor circulation, such as diabetes, Raynaud’s phenomenon, peripheral arterial disease, and peripheral neuropathy
- Tight-fitting clothes (boots, socks, gloves, long johns)
- Certain medications, including beta blockers
What should you do if you think you or your child may have frostbite?
If you recognize symptoms of frostbite, immediately go indoors where it is warm. Try to gradually warm up and bring back feeling to the skin. (But avoid rubbing frostbitten skin—the friction can further damage skin cells.)
Remove any jewelry or constrictive clothing. And don’t warm up in front of a fire or heater. Because frostbitten skin is numb, you may not realize how close you are to the heating source and may burn your skin.
A method dermatologists recommend is to apply a warm washcloth to the affected area to bring gradual warming. Follow this by immersing the affected area in warm (never hot or cold) water or simply wrapping yourself up in blankets. You can also use your body heat to warm your child’s skin.
When should you seek medical help for frostbite?
If you notice your skin developing a gray, white, yellow, blue, or black discoloration, or if you do not feel sensation returning to numbed skin after trying to rewarm the area, seek medical attention immediately at a hospital emergency room. In addition to being assessed for frostbite, you’ll be checked for hypothermia. This is a serious medical condition in which the body temperature is so low that brain function is affected, causing confusion, low energy, drowsiness, memory loss, altered speech, shivering, and exhaustion.
Frostbite can affect not only deeper layers of skin, but also muscles, bones, and blood vessels. If the blood vessels are damaged, they may never recover. Without proper blood flow to the affected area, gangrene can develop, which occasionally can only be treated by amputating the affected limb.
What medications are used to treat frostbite?
Medications may be used to relieve pain and prevent infection and, in some cases, amputation. They may include:
- Pain medications. Rewarming affected parts of the body can cause significant pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. Aspirin may be used to reduce pain, though it may slow healing. Opioids may also be given to treat pain.
- Antibiotics. In some cases, infections can occur in parts of the body affected by frostbite. Intravenous antibiotics may be given as part of treatment.
- Tetanus vaccine. Because people with frostbite are at increased risk for bacterial wound infections, such as tetanus, a tetanus shot may be given.
- Medications to prevent blood clotting and improve blood flow. Blood clots can form in small blood vessels in parts of the body affected by frostbite. Clots can restrict blood flow in the affected parts of the body. Blood flow to frostbitten tissue may cease, leading to the need to amputate affected tissue. Medications called thrombolytics (or thrombolytic therapy) may be given to break up blood clots and vasodilatory drugs may be given to widen blood vessels, thereby improving blood flow and reducing the need for amputation.
These drugs are usually given intravenously (by IV) or intra-arterially (into the arteries). Drugs in these categories include:
- Thrombolytic therapy with heparin. Heparin, a blood thinner, may be used in combination with a thrombolytic drug such as alteplase.
- Iloprost. This drug, sold under the brand name Aurlumyn™, is a vasodilator, meaning it works by dilating, or widening, blood vessels, thereby improving blood flow through the vessels. In February 2024, the Food and Drug Administration (FDA) approved iloprost for the treatment of severe frostbite in adults to lower the risk of amputation of fingers or toes. It is given by IV infusion.
How can I prevent frostbite?
Proper preparation is the key to preventing frostbite. The American Academy of Dermatology shares the following tips:
- Dress in loose, light, comfortable layers: Wearing loose, light layers helps trap warm air. Your first layer should be made of a synthetic material, which can wick moisture away from your body. The next layer should be insulating—wool and fleece hold in more heat than cotton fabrics. Choose a windproof and waterproof (or water-resistant) outer layer.
- Cover up: Be prepared with proper winter wear. What you believe to be a brief time outdoors could easily turn into hours in frigid temperatures due to unforeseen events, like a car accident (or breakdown) or locking yourself out of the house.
- Protect your feet: If you take part in cold-weather activities, double up your socks to protect feet and toes. Wear a moisture-wicking pair of socks to keep the feet dry, then add a wool or wool-blended sock for warmth. Be sure your boots are insulated and high enough to keep snow out.
- Hats: Hats protect your head and ears, and scarves and face masks can help prevent frostbite on the ears, nose, cheeks, and chin.
- Avoid metal: Since metal conducts cold, do not to touch metal surfaces with bare skin.
- Keep skin dry. Seal out snow, ice, and rain with waterproof or water-resistant outerwear, and change out of clothing that becomes damp from the elements or perspiration.
- Stay hydrated: Drink a glass of water before you head outside, and sip water or a sports drink before and throughout outdoor workouts—dehydration slows blood circulation.
What is Yale Medicine's approach to treating skin affected by frostbite?
“A thorough understanding of the scenario, careful physical examination, and prompt management are key, but there’s also an important opportunity for education about the condition, assessment of underlying risk factors, and review of tools for prevention,” Dr. Perkins says.
