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Frostbite Content Supplied by NHS Choices
Symptoms of frostbite

The symptoms of frostbite progress in three stages.

The colder the temperature and the longer the body is exposed to freezing conditions, the more advanced frostbite can become.

Early stage (frostnip)

During the early stage of frostbite, you'll experience pins and needles, throbbing or aching in the affected area. Your skin will become cold, numb and white, and you may feel a tingling sensation.

This stage of frostbite is known as frostnip, and it often affects people who live or work in cold climates. The extremities, such as the fingers, nose, ears and toes, are most commonly affected.

Intermediate stage

After these early signs of frostbite, prolonged exposure to cold temperatures will cause more tissue damage. The affected area will feel hard and frozen.

When you're out of the cold and the tissue has thawed out, the skin will turn red and blister, which can be painful. There may also be swelling and itching.

This is known as superficial frostbite, because it affects the top layers of skin and tissue. The skin underneath the blisters is usually still intact, but treatment is needed to make sure there's no lasting damage.

Advanced stage

When exposure to the cold continues, frostbite becomes increasingly severe. The skin becomes white, blue or blotchy, and the tissue underneath feels hard and cold to touch.

Further damage may occur beneath the skin to tendons, muscles, nerves and bones. This is known as deep frostbite and requires urgent medical attention.

As the skin thaws, blood-filled blisters form and turn into thick black scabs. At this stage, it's likely that some tissue will die. This is known as tissue necrosis, and the affected tissue may have to be removed to prevent infection.

Long-term effects

People with a history of severe frostbite often report further long-term effects of frostbite. These can include:

  • increased sensitivity to cold
  • numbness in the affected body parts, most commonly the fingers
  • reduced sense of touch in the affected body parts
  • persistent pain in the affected body parts
Treating frostbite

Treatment for frostbite depends on the severity of your symptoms. Always seek medical attention if you think you or someone else has frostbite.

If the symptoms of frostbite are minor, call your GP or NHS 111 for advice.

If the symptoms are severe, go immediately to your nearest accident and emergency (A&E) department. If you're unable to move, call 999 to ask for an ambulance.

First aid

If medical assistance isn't available, the following steps can be taken to treat frostbite and hypothermia:

  • Move to a warmer place (if possible) - it's best to avoid walking on frostbitten feet and toes, because it can cause further damage (although in emergency situations this may not always be possible).
  • Replace wet clothing with soft, dry clothing to stop further heat loss.
  • Warm the body by wrapping it in blankets and protecting the frostbitten parts.
  • Don't rub the affected area or apply direct heat (such as from a fire or heater) because this can cause further injury.
  • Don't smoke if you have frostbite (or allow someone else with frostbite to smoke) because smoking can affect blood circulation.

Read more about treating hypothermia.

Re-warming the frostbitten areas

The frostbitten areas need to be re-warmed. Re-warming shouldn't be attempted until you're out of the cold. If the warming process is started and the frozen parts are then re-exposed to the cold, it can cause further irreversible damage.

Re-warming should ideally be carried out under medical supervision, because it can be a painful process requiring painkillers and expert medical assessment. The best results are achieved using a whirlpool bath that contains a mild antiseptic.

The affected area should be re-warmed slowly by immersing it in warm (but not hot) water. A bath of water at a temperature of 40-41C (104-105.8F) is recommended.

Re-warming should last at least 30 minutes and should only be stopped once the affected body part is a red-purple colour and can be easily moved.

This process can be repeated twice a day until there are clear signs that the affected body part is beginning to heal, such as the growth of new skin and the return of normal skin colour.

Depending on the severity of pain, very strong painkillers, such as morphine, may be needed. Ibuprofen should also be taken, because it has additional protective properties for frostbite.

After re-warming

After the frostbitten area has been thawed, it should be gently wrapped in clean bandages, with the fingers and toes separated. It's very important to keep the skin clean to avoid infection.

Too much movement should be avoided, and the limbs should be raised if possible. Avoid walking on affected feet and toes that have been re-warmed, because the tissues will be very delicate.

After re-warming, the skin will be discoloured and blistered, and will eventually scab over. If the frostbite is superficial, new pink skin will form beneath the discoloured skin and scabs. The area usually recovers within six months.

Severe frostbite

If you have severe frostbite, you'll need to be admitted to a specialist unit where medical staff have experience in treating these types of injuries. This is often a specialist burns unit, because exposure to very high temperatures can cause the same type of injury as exposure to very cold temperatures.

If there's a very high risk of major damage, you may have thrombolytic therapy (tPA). Medication will be given as injections or through a drip in your arm to help break up small clots in the frostbitten blood vessels.

This should improve blood flow to the affected body part, which can stimulate healing and prevent further damage. You may also be given antibiotics to prevent the affected body part becoming infected.

Iloprost is sometimes used to treat very severe cases of frostbite. It works by widening the blood vessels that supply blood to the affected body part.

When severe frostbite threatens the loss of a limb, finger or toe, a person should be considered for treatment with tPA or iloprost within 24 hours of the injury occurring. Experience has shown that treatment given within this timeframe has the best outcomes in terms of saving the affected body part. However, these treatments could still be considered as an option within an experienced unit after 24 hours.

If some of the tissue of the affected body part has died (a condition known as gangrene), it will need to be removed. The procedure to remove dead tissue is called debridement. In the most serious cases, an entire part of the body, such as the fingers or toes, may need to be removed (amputated).

A decision to perform debridement or amputation is usually delayed for several weeks, as often what appears to be dead tissue can heal and recover over time.

Long-term effects

After having frostbite, some people are left with permanent problems, such as increased sensitivity to cold, numbness, stiffness and pain in the affected area.

Unfortunately, not much can be done to treat sensitivity to cold, numbness or stiffness. A medication called amitriptyline can sometimes be effective in controlling the pain associated with the long-term effects of frostbite.

 
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