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  • Frostbite

Published on January 29, 2014


By Mark Doohen, MD
Avera Sacred Heart Hospital Emergency Room Physician

With the cold weather we’ve been experiencing, it’s important to realize that if proper precautions aren’t taken, frostbite can occur anytime the temperature hits 32 degrees Fahrenheit or less.

Frostbite is a medical condition that can happen to anyone. Frostbite occurs when the skin or tissues under the skin freeze and cell damage is caused. Most commonly, frostbite will strike first in the extremities such as fingers, toes, ears, face and nose. These parts of the body typically have the poorest circulation and are most susceptible to frostbite. However, any part of the body exposed to freezing temperatures can experience frostbite.

As a natural reaction to cold temperatures, the blood vessels, especially in the extremities, constrict to prevent body heat loss. When these parts of the body lose that warming blood flow, the fluid inside the cells and tissues can freeze into ice crystals. As with any liquid, this fluid takes up more space in a frozen state than a liquid state and can cause the cells to rupture, sometimes causing permanent damage.

Cold Skin Injuries:

  • Frostnip – Localized tingling and burning with re-warming, not damaging
  • Chilblain – Skin injury from exposure to cold (above freezing); red or purple, swollen
  • Frostbite – Kills cells by freezing tissue, goes through different levels of tissue damage (similar to burns)

The good news about frostbite is that it is preventable with just a minimum amount of effort. Factors such as wind chill, alcohol consumption, length of exposure and being wet or damp can all contribute to frostbite. It’s important to remember that the temperature to which the skin is exposed needs only to be 32 degrees for frostbite to occur. Although extreme cold is an obvious cause of frostbite cases, prolonged exposure to temperatures below 32 degrees can have the same effect. Wet, cold socks while hiking in the wintertime can cause frostbite in the toes. Wearing clothes that are too heavy causing a person to perspire can also be a dangerous factor in frostbite – dampness and moisture are the enemy in cold temperatures. It’s much better to wear several layers of clothes that can be removed or added as necessary.

The following are a few more tips to avoid frostbite:

  • If temperatures and windchills are extreme, stay inside.
  • Protect the most vulnerable parts of your body. Wear mittens (much better than gloves) for your hands and fingers. Wear a stocking hat (or ski mask) for your head, face and ears. Wear a scarf to protect your neck and throat area.
  • Proper footwear is especially important. Shoes and boots should be waterproof and not too tight. Boots with Gortex (or similar products) allow moisture vapor to exit while preventing liquid water from entering. With these boots, choice of socks is not as important, but if your footwear is waterproof but can’t “breathe,” use wool socks only.
  • Thermal underwear is recommended.
  • Avoid alcohol and tobacco use (Both, especially alcohol, seriously hamper the body’s circulatory ability and change the perception of threat by frostbite)
  • Be active to promote better circulation. Walk, stomp or jump around to keep blood flowing throughout entire body.
  • Simply be aware of the conditions that can cause frostbite – extreme cold, wet clothes, high winds and poor circulation. Poor circulation can be caused or made worse by tight clothing or boots, cramped positions, fatigue, certain medications, smoking, alcohol use, or diseases that affect the blood vessels such as diabetes.

If you or someone you’re with experiences frostbite, take the following actions:

  • Shelter the victim from the cold and move the victim to a warmer place
  • Remove any constricting jewelry and wet clothing
  • Immerse the affected areas in warm (NOT HOT) water – or apply warm cloths to the affected areas for 20 to 30 minutes. Keep circulating the water to aid the warming process. Burning pain, swelling and color changes may occur during warming. Warming is complete when the skin is soft and sensation returns, even if it is painful sensation
  • Apply dry, sterile dressing to the frostbitten areas. Put dressings between frostbitten fingers or toes
  • Move thawed areas as little as possible
  • Prevent refreezing by wrapping the warmed areas
  • If the frostbite is extensive, give warm drinks to the victim in order to replace lost fluids
  • Seek medical treatment immediately if frostbite is anything more than superficial


  • DO NOT thaw out a frostbitten area if it cannot be kept thawed. Refreezing may make tissue damage even worse
  • DO NOT use direct heat (such as radiator, campfire, heating pad or hair dryer applied directly to the frostbitten area). Direct heat can burn the tissues that are already damaged
  • DO NOT rub or massage the affected area
  • DO NOT disturb blisters on frostbitten skin
  • DO NOT smoke or drink alcoholic beverages during recovery as both can interfere with blood circulation

Call immediately for emergency medical assistance if:

  • There has been severe frostbite and feeling and color does not return after home treatment.
  • Frostbite has occurred recently and new symptoms develop, such as fever, malaise, discoloration or drainage from the affected body part.
  • Frostbite has occurred and symptoms of hypothermia are present.

Remember that if you have any doubt whatsoever, it’s best to seek medical treatment from a trained health care professional. Better yet, avoid situations that can result in frostbite. Enjoy the winter season, but enjoy it in moderation and using all possible precautions for safety.