Frostbite

Frostbite is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A severe localized injury due to cold exposure, causing tissue to freeze, resulting in direct cellular injury and progressive dermal ischemia (most commonly of exposed hands, feet, face, and ears)
  • Systems affected: integumentary, vascular, muscular, skeletal, nervous
  • Synonym: dermatitis congelationis

Epidemiology

  • Predominantly adults but can affect all ages
  • Predominant sex: male = female

Etiology and Pathophysiology

  • Prolonged exposure to cold
  • Refreezing thawed extremities
  • Ice crystals form intracellularly and extracellularly.
  • Vasoconstriction reduces blood flow, and microvascular endothelial injury leads to ischemia.
  • Cellular dehydration leads to abnormal electrolyte concentrations and cell death.
  • In severe cases, tissue injury extends to muscle and bone leading to necrosis and mummification.
  • Rewarming injured endothelium results in edema and bullae.
  • Inflammatory mediators such as prostaglandins and thromboxane A2 induce vasoconstriction and platelet aggregation, worsening ischemia.

Risk Factors

  • Prolonged exposure to below freezing temperatures, especially combined with wind and/or water exposure
  • High-altitude activities, such as mountaineering
  • Military operations in cold environments
  • Constricting or wet clothing with inadequate insulation
  • Altered mental status due to alcohol, drugs, or psychiatric illness
  • Homelessness
  • Previous cold-related injury
  • Dehydration and/or malnutrition
  • Smoking
  • Raynaud phenomenon
  • Peripheral vascular disease
  • Diabetes

General Prevention

  • Dress in layers with appropriate cold weather gear and avoid clothing that is too constricting.
  • Cover exposed areas and extremities appropriately.
  • Stay dry; avoid alcohol and minimize wind exposure.
  • Ensure adequate hydration and caloric intake.
  • Use supplemental oxygen at very high altitudes (>7,500 meters).
  • Exercise can protect against frostbite by increasing core and peripheral temperatures.
  • Appropriate use of chemical or electric hand and foot warmers can help maintain peripheral warmth.

Commonly Associated Conditions

  • Hypothermia
  • Alcohol or drug abuse

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