How to Treat Frostbite

Frostbite occurs when skin is exposed to freezing temperatures for a prolonged period. Commonly affected areas include the fingers, toes, nose, ears, cheeks, and chin. In severe cases, the damaged tissue may need to be amputated. Most frostbite cases only affect the skin layer (frostnip), but in serious situations, the dead tissue may extend deeper and require careful medical intervention. Frostbite requires meticulous medical attention to minimize damage and prevent further complications.

Identify frostnip. Frostnip is not the same as frostbite, but it can lead to frostbite. Ice crystals form on the skin’s surface without penetrating the tissues as in frostbite. The blood vessels in the skin constrict, causing the affected area to appear pale or red. You may experience numbness, tingling, or a sensation similar to ants crawling or pricking in the affected area. However, the skin still responds normally without severe numbness when pressed and maintains its natural structure. The symptoms will subside once the skin warms up.

• Frostnip can affect children more quickly than adults. It typically affects extremities such as the ears, nose, fingers, toes, and cheekbones.
• Frostnip is an indication that the weather conditions are severe enough to cause frostbite with prolonged exposure.

Identify superficial frostbite. Although it might not feel 'superficial,' this type of frostbite is termed superficial because the damage is treatable. It is more severe than frostnip, with symptoms such as numbness, white or slightly yellowish-gray skin, red spots, pain, tingling, mild stiffness, or swelling.

• Superficial frostbite is less likely to result in tissue loss. Some individuals with superficial frostbite may develop fluid-filled blisters within 24 hours. These blisters often appear on the extremities of the affected area but do not cause tissue loss.

Identify severe frostbite. Severe frostbite is the most dangerous form of frostbite. In severe cases, the affected skin turns pale, thick, and unusually stiff, with numbness or loss of sensation. Some severe frostbite cases may result in blisters containing blood or signs of gangrene (gray/black dead skin).

• The most severe frostbite extends deep into the muscles and bones, potentially causing death of the skin and tissue. The risk of tissue loss is very high in this case.

Get out of the cold and seek treatment as soon as possible. If you can reach a hospital or emergency room within two hours, you should not attempt to treat frostbite on your own. If you cannot leave the cold environment, do not try to warm the affected area if there is a risk of refreezing. The freezing-thawing cycle can cause more damage than continuous freezing.

• If you cannot access medical care within two hours, you can begin self-treatment. All three conditions—frostnip, superficial frostbite, and severe frostbite—follow the same basic emergency treatment steps (away from a hospital).

Begin warming the affected skin. As soon as you notice frostbite on your skin (usually appearing on fingers, toes, ears, and nose), you should take steps to warm the affected parts. Place your fingers/hands under your armpits, or gently press your gloved hands to your face, toes, or other affected areas to warm them up. Remove any wet clothing, as damp clothes can hinder the body from raising its temperature.

Take pain relief medication if necessary. If you have a superficial or severe cold burn, warming the skin can be painful. To prevent further injury, you should take anti-inflammatory nonsteroidal drugs (NSAIDs) like ibuprofen. Avoid aspirin as it can slow down the healing process. Follow the dosage instructions on the medication packaging.

Warm the cold burn area by soaking it in warm water. Fill a basin or bowl with water heated to about 40-42°C. A temperature of 40.5°C is considered ideal. Do not exceed this temperature as higher temperatures can cause burns and blisters. If available, you can add a small amount of antibacterial soap to the water to prevent infection. Soak the affected area for about 15-30 minutes.

• If a thermometer is unavailable, test the water temperature by dipping an unaffected area, such as your hand or elbow, into the water. It should feel very warm but still tolerable. Let it cool if it's too hot.
• If possible, use running water instead of still water, as moving water is better. A wave pool is ideal, but running tap water can also be helpful.
• Be sure not to let the injured area touch the edge of the basin or bowl, as this can harm the skin.
• Continue warming the skin for at least 15-30 minutes until the frostbite has thawed. You may experience severe pain as the skin thaws, but it is important to continue warming the skin until completely thawed. Stopping the process too early could cause more damage.
• In severe cold burns, you may need to warm the skin for up to one hour.

Avoid using dry heat sources such as stoves, heaters, or hot water bottles. These sources of heat are difficult to control and do not provide the gradual warmth needed to treat a cold burn, and they can also cause burns.

• Remember that the affected area will be numb, and you will not be able to measure the temperature. Dry heat sources cannot be precisely controlled.

Monitor the affected skin area. Once the skin has warmed up, you may feel sensations like tingling or burning. The affected skin will turn pink or red, often with marks, and return to its normal texture/feeling. The skin should not be swollen or blistered. If these symptoms appear, it indicates more severe damage and requires immediate medical attention. Additionally, if the skin shows no improvement after soaking in warm water for several minutes, it may indicate severe damage that needs medical care.

• If possible, take a photo of the affected skin. This will help doctors track the progression of the condition and determine if the wound is improving with treatment.

Prevent further injury. Continue seeking medical attention, but during the process, take steps to avoid worsening the cold burn. Do not rub or scrub the affected skin, avoid excessive movement, and ensure the injured area does not come into contact with extremely cold temperatures again.

• Once the skin has warmed up, let it dry naturally or gently pat it with a clean towel, but do not rub the skin.
• Do not bandage the wound. There is no evidence supporting the use of bandages on cold burns before receiving medical care, and this may restrict movement.
• Do not massage the cold burn area. This could cause further tissue damage.
• Elevate the affected area to help reduce swelling.

Continue medical treatment. Doctors will apply different cold burn treatments depending on the severity of the injury. Hydrotherapy is the most common treatment method, but in extreme cases, surgery may be required. If the cold burn is severe, the doctor may limit the area that needs to be amputated, but this decision is made 1-3 months after assessing the extent of tissue damage.

• Doctors will ensure the skin is warmed correctly and evaluate 'non-survivable tissue,' or tissue that cannot heal. Once treatment is complete, and you're ready to leave the hospital or emergency room, the doctor will bandage the affected area and provide instructions on necessary precautions during recovery. This can vary depending on the severity of the cold burn.
• If the cold burn is severe, the doctor may recommend transferring you to a burn unit for further treatment.
• You will need to follow up within 1-2 days after leaving the hospital or emergency room for moderate to severe cold burns. In extremely severe cases, follow-up may be required in 10 days to 2-3 weeks.

Consult with your doctor about post-treatment care. Cold burns damage the skin, which increases the risk of further harm as it heals. You may experience pain and swelling during recovery. It is important to rest and discuss the following with your doctor:

• Apply aloe vera. Studies show that pure aloe vera cream can help prevent further skin damage and promote faster healing of tissues.
• Care for blisters. As your skin recovers, blisters may form. Do not pop or burst them. Ask your doctor how to manage these blisters until they heal naturally.
• Pain management. Your doctor may prescribe ibuprofen to help reduce pain and inflammation. Be sure to follow the prescribed dosage instructions.
• Prevent infection. Your doctor may prescribe antibiotics, especially in severe cases. It is crucial to complete the full course as prescribed by the doctor.
• Mobility restrictions. If the cold burn is on your foot or toes, avoid walking on the injured area while it heals. Walking on the burn can cause additional damage. Discuss with your doctor the use of a wheelchair or other mobility aids.

Protect the injured area from the cold. To ensure complete healing and prevent further damage, you must avoid exposing the wound to cold temperatures for 6-12 months.

• To prevent future cold burns, limit your outdoor time during extreme cold weather, especially when it is windy or damp.

• Once a cold burn in the limbs has been warmed, it is essential not to let it refreeze. Refreezing can cause irreversible damage.
• Do not warm the injured area with dry heat sources such as fire (in any form), hot water bottles, or heat packs, as you will not feel the temperature. The injured skin can easily get burned.
• If your hands are numb, you won't feel the warmth of the water, so ask someone else to check the water temperature to avoid burns.
• Avoid smoking or drinking alcohol during recovery; both can impair blood circulation.
• Do not use the injured skin after it has been warmed until it has fully healed. Otherwise, you may cause further damage.
• Children are affected by cold more quickly than adults. Keep an eye on children whenever they are outside in cold weather.
• In extremely cold weather, cold burns can occur in as little as 5 minutes.

• Warm water
• Antibacterial soap
• Pain relievers
• Shelter