Frostbite

Overview

What is frostbite?

Frostbite is a potentially permanent condition that happens when your body tissues (like fingers, toes, ears) are injured by exposure to cold weather or cold water. You’re more likely to get frostbite during winter, in windy weather and at high altitudes. Even though your exposed skin gets frostbitten first, it can still happen even if your skin is covered.

How cold does it have to be to get frostbite and how long does it take?

Single-digit Fahrenheit temperatures are cold enough to cause frostbite. It’s important to remember that the colder it is outside, the faster you can get symptoms. In fact, you can get frostbitten in just half an hour or less when the wind chill is -15F (-26 C) or lower.

How is frostbite different from hypothermia?

Hypothermia happens when your body temperature drops below 95° F (35° C). Your normal body temperature is about 98.6° F (37° C). Hypothermia is more serious and widespread in your body than frostbite, which affects specific parts of your exposed skin. Frostbite happens when part of your body freezes, damaging your skin cells and tissues. Just like ice coating your windshield, your skin becomes hard and white when frostbitten. You can get both hypothermia and frostbite at once, and both are medical emergencies.

Who is at risk for frostbite?

If you’ve got exposed skin in cold temperatures, you’re at risk of frostbite. You’re also at a higher risk of developing frostbite if you:

  • Take medicine for high blood pressure.
  • Have diabetes.
  • Smoke.
  • Have peripheral vascular disease, a serious condition involving blood vessels.
  • Have Raynaud’s phenomenon (Raynaud’s disease), a condition that involves periodic narrowing (or spasms) in the blood vessels.
  • Have poor circulation or dehydration.
  • Haven’t dressed appropriately for cold weather or high altitude (swimming, hiking or climbing).
  • Are an infant.
  • Are elderly.
  • Have a physical or mental condition that prevents you from protecting yourself against the cold (like fatigue, mental illness, heavy sweating).
  • Have been drinking alcohol or taking drugs.

What are the 3 stages of frostbite?

Frostbite begins with mild symptoms but quickly becomes a serious health risk the longer your skin freezes from exposure. There are three stages of frostbite, including:

  • Frostnip: During frostnip, if you notice symptoms at all, you may see that the affected skin is red or a pale white. The skin may also feel cold, numb or tingly. Frostnip is the warning stage when skin damage is still just temporary. So if you notice symptoms, get inside immediately and treat the area with warm (never hot) water. Afterward you may get small red bumps (chilblains) on your skin.
  • Superficial (surface) frostbite: In the second stage, your skin might feel warm, but the water in your skin is slowly freezing into ice crystals. Your skin may also sting or swell up. After rewarming, you might see mottled patches or purple or blue areas that hurt or burn (just like a bruise). Your red skin might start to peel and hurt just like a sunburn — and you need to seek immediate medical treatment. You may also get fluid-filled blisters in the area after a day or so.
  • Severe (deep) frostbite: In the third stage, your lower layers of skin (subcutaneous tissue) freeze and total numbness in the area sets in. You may be unable to move the area that’s frostbitten or you may not be able to move it normally. Get medical attention immediately. Big blisters will appear on the frostbitten skin a day or two afterward. Finally, the frostbitten skin turns black as its cells die from freezing. This black skin might form a hard black covering (carapace) that falls off on its own — otherwise it will usually need to be removed surgically.

If you notice any of the symptoms of the second or third stages of frostbite, get immediate medical treatment to help prevent long-lasting damage.

Symptoms and Causes

What causes frostbite?

Frostbite happens when your skin is exposed to cold temperatures or cold water. It can also happen when you’re exposed to temperatures that aren’t quite as cold, but you’re exposed for a longer period of time. Ice packs and cold metal can cause frostbite if they’re pressed directly against your skin. You can even get frostbite through clothing, including your fingers when you’re wearing gloves.

During frostbite, the water in your skin freezes, causing visible and invisible damage to your cells and soft tissues. Frostbite usually affects your extremities (fingers, toes and ears) first. But it’s just as easy to get frostbitten on your cheeks and chin. The cold can injure both your skin and the tissues underneath — like muscles, nerves and joints.

What are the symptoms of frostbite?

Frostbite becomes more severe as your skin temperature drops or the longer your skin stays exposed. Frostbite symptoms include:

  • Numbness.
  • A painful feeling of “pins and needles” in the exposed area.
  • Hardening of your skin that’s been uncovered skin too long in the cold.
  • Redness (for mild frostbite).
  • Pale or waxy color and feel (for more severe frostbite).
  • Swelling.
  • Blisters (clear or blood-filled) or scabs.
  • Loss of coordination (stiff movements, falling down).
  • Pain when rewarming the affected area.

What does frostbite feel like?

Frostbite is so dangerous because it often numbs your skin first, so you may not feel that anything’s wrong at all. You might feel pain in your skin that’s exposed to the cold. Or your skin might feel suddenly hard or soft. Severe frostbite often causes your skin to swell up, and you might also get uncomfortable blisters. You may start feeling feverish or suddenly clumsy.

What are the complications of frostbite?

When frostbite continues past the first stage (frostnip), it can have long-term or permanent side effects. You might feel symptoms of nerve damage (neuropathy), like always feeling numb, sweating heavily or being more sensitive to cold. You’re also more likely to get frostbitten again once it’s happened. Frostbite arthritis — stiffness usually found in the hands and feet — can settle in your joints months or even years later.

Your skin itself might change color, or your fingernails might be damaged or lost. If the skin has turned black, you’re also at risk of getting gangrene (a condition where the skin rots) or becoming infected. Knowing how severe and long-lasting frostbite is can help you take steps to prevent it.

Diagnosis and Tests

How is frostbite diagnosed?

There are no simple tests to tell how badly you’ve been frostbitten. Typically, your healthcare provider will diagnose frostbite by looking at the area, asking you about how long (and in what temperatures) you were out in the cold, and monitoring your symptoms over time. Depending on how severe your frostbite is, your provider may need to take an X-ray or use another imaging method.

During the physical exam, your provider will look to see if your skin turns white or red, gets blisters or turns black (the tissue dies). Clear blisters often mean the damage to your skin is temporary, but blood-filled blisters mean the damage is long-term. If your skin turns black but doesn’t shed, a surgeon will probably have to remove it to prevent gangrene.

Management and Treatment

How is frostbite treated?

Time is critical when you have frostbite. If you notice frostnip symptoms like pain or red fingers, get inside quickly and gently warm your skin. If you’re experiencing any symptoms from the second or third stages of frostbite, seek emergency medical help right away. Remove all wet clothing, wrap the affected area in a sterile (clean) cloth and then immediately go to the emergency room. Hospital staff will then:

  • Help raise your body temperature in lukewarm water or by applying warm, wet packs for up to half an hour.
  • Dress your frostbitten or wounded skin with sterile bandages, keeping your fingers and toes separated to avoid rubbing.
  • Test blood flow in the area. If you have stage three frostbite, your provider may also connect you to an IV bag (pouch with fluids) to improve poor circulation.
  • Give you antibiotics and pain relievers, such as ibuprofen (Advil ®, Motrin ®), for example.
  • Possibly give you a tetanus booster, if needed, since frostbite puts you at higher risk for tetanus.
  • Rehydrate you by giving you water (frostbite dehydrates your tissues).
  • Give you oxygen therapy. For extreme frostbite, your provider may have you breathe pure oxygen inside a pressurized room. This treatment, called hyperbaric oxygen therapy, helps some people heal faster by increasing their blood-oxygen levels.

Never treat frostbite with anything hot to the touch. Avoid using space heaters, electric blankets, fireplaces or hot water.

Do I need surgery for frostbite?

In some cases, your provider may need to perform surgery to remove any dead skin and tissue after you heal (this may take days or even months). In the case of severe (deep) frostbite, surgeons may need to remove (amputate) the fingers or toes if the tissue has died or gangrene has developed.

How do you treat frostbite by yourself?

If you’re in a remote area or you’re unable to go to the hospital, your first priority is to make sure you’ll stay warm and not refreeze — as this can cause further skin damage. To warm back up, follow these steps:

  • Remove all wet clothing.
  • Elevate the injured area slightly.
  • Warm your skin by soaking the frostbitten area in warm water (around 105 F or 40.5 C). Since the skin may be numb, be careful not to burn it with hot water. Burning could cause more damage to the tissue. When your skin feels soft again, you can stop warming it.
  • Cover the frostbitten area with sterile (clean) cloth. If your fingers or toes are frostbitten, wrap each one individually. Make sure you keep them separated to avoid stress or pressure.
  • Try not to move the area at all. Avoid walking on frostbitten toes or feet.
  • Don’t rub frostbitten areas because rubbing skin that’s hard or numb can cause tissue damage.

Can you have frostbite and not know it?

Many people who get frostbite are completely unaware that they have it. Because frostbite numbs your nerves and can cause damage deep inside your skin, you might not notice any symptoms after coming in from the cold. Stay safe by going inside and warming back up.

What if my child has frostbite?

You might not know if your child has frostbite. Infants don’t shiver like adults because they don’t have as much energy stored up. And older children are usually too busy having fun outside to notice they’re frostbitten.

If your baby or toddler has recently been outside in the cold for even 10 minutes, it’s time to check on them. If you notice parts of their skin are red, white or gray, immediately call 911. If your children are older and they’ve been outside too long without covering up completely, remove their wet clothing and dry them under blankets. Leave the affected areas uncovered but elevated. Use a tub full of warm — but not hot — water to help children of any age recover from the cold.

Prevention

How can you prevent frostbite?

Stay safe and take simple precautions to help prevent frostbite and its symptoms.

  • Avoid going outside: When it’s cold out, try to stay indoors.
  • Limit your trips: If you do have to go outside, try to limit it to 10 or 15 minutes before going back inside for a few hours.
  • Dress warmly before going out: Dress appropriately whenever you know you’re going to be in cold temperatures. Layer your clothing, wear two pairs of socks, a thick hat, mittens (never gloves — gloves don’t keep your fingers together to warm them) — and a heavy scarf over your face and mouth. Keep your ears covered since they’re so easily frostbitten.
  • Wear windproof and waterproof clothing: Wear clothes designed to keep the weather out and to keep your head and neck area warm.
  • Don’t cut off your circulation: Make sure your boots and clothes aren’t too tight. This can cause poor circulation. Avoid cramped positions and stay moving to keep a good blood flow.

When traveling in cold weather, always bring your phone with you. It’s your lifeline to medical help if you have an accident or get stuck on the road. Finally, pack a car emergency kit in your vehicle. That way you’re prepared with first aid, food and water, gloves, boots and blankets whenever the weather turns bad.

Can animals get frostbite?

Remember you’re not the only one who can get frostbite — your pets can too. Be sure to keep them warm inside when cold weather’s on its way. Don’t wait until it’s already snowing to let dogs back in or to stable your horses.

Outlook / Prognosis

How long does it take to recover from frostbite?

Recovery and treatment depend on which stage of frostbite you were in, and how long you were in it. The first stage’s symptoms are often just temporary. However, the second and third stages usually cause permanent skin and tissue damage. If your exposure was very serious, you may lose the affected limb, finger or toe to autoamputation (where your limb or finger or toe falls off on its own) or surgical amputation.

If you suffer mild to moderate frostbite, you may become sensitive to cold and pain — and you may also have ongoing numbness. And if you suffer severe or “deep” frostbite, you might also have:

  • Damage to your tendons, muscles, nerves and bones.
  • Arthritis, bone deformities, scars and skin and nail changes or weakness.
  • Gangrene (blackened, dead tissue).

What can I do to help my skin heal from frostbite?

Help your skin heal by staying warm inside. Once you’ve been frostbitten, the worst thing you can do is to go back outside that day, even after you’ve warmed back up. Keep your injured skin elevated and don’t walk on your feet or toes if they hurt. Replace your tight socks with loose-fitting ones to reduce swelling. Anti-inflammatory medications and pain relievers can help if you feel any swelling or burning pain. Applying soft lotion can help you relieve frostnip symptoms.

Note From Cleveland Clinic:

Stay safe inside or make sure everyone dresses warm whenever cold weather’s about to roll in. Not only will you feel more comfortable, you’ll also help protect yourself and your loved ones against frostbite and all the serious health risks that go along with it. If you’ve been exposed to the cold for more than half an hour in extremely cold conditions and think you may have frostbite, be sure to seek immediate medical attention.

Last reviewed by a Cleveland Clinic medical professional on 05/21/2020.

References

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy