Frostbite is a damage of the body caused by a physical mechanism, in this case by the cold. In developed countries, it is encountered most often in homeless people and in alcoholics, who have fallen asleep outside in winter. Frostbite has quite a lot common with burns.


Frostbite most commonly affects the peripheral and less vascularized parts of the body (nose, ears, and peripheral parts of limbs). The damage is a combination of the direct effect of cold and of protective reaction of the organism. The cold damages cells and the body tries to reduce the heat loss by closure of subcutaneous blood vessels, thus causing local hypoperfusion (decreased transport of oxygen and nutrients), which further decreases resistance of the affected tissues to cold.


Note: “Local frostbite" is commonly used in therapeutic method known as cryosurgery when skin lesions (such as warts) are destroyed by extremely cold liquid nitrogen.


The symptoms of frostbite depend on their degree. The higher the degree is, the more serious the manifestation is.

1st degree frostbite

The affected skin gets reddish or pale and cold, local sensitivity is increased and the patient feels cold and painful sensations. If warmed up, the body parts may become painful and the victim suffers from very unpleasant burning sensations.

2nd degree frostbite

The skin is cold, from pale to white and there is a disruption of local sensitivity. In days after the frostbite occurrence, local skin blisters are formed.

3rd-4th degree frostbite

The skin loses sensitivity, it is heavily damaged and in days following the frostbite, it blackens and succumbs to necrosis (dry gangrene). Destructed tissues may be easily infected by bacteria and such situation endangers the patient by possible development of sepsis.


The diagnosis is usually made by the naked eye in a patient that has longer stayed in a cold environment in recent time. High age, alcoholism and chronically reduced nutrient intake significantly worsen the general prognosis. Similarly, diabetics and patients suffering from polyneuropathy are more vulnerable to frostbite as they are less sensitive in the peripheral body parts and may not realize the damage at first.


The treatment should be rather cautious and the patient should be slowly warmed to a normal temperature. Aggressive rapid warming is not recommended. It is advisable to put the injured body parts into lukewarm water. Any blisters should not be punctured as we consider them a natural defense of the organism. Adequate nutrition and hydration is highly advisable. Any infectious complications are treated with antibiotics. Severe frostbite with local gangrene must be often treated surgically with amputation of the affected body part or even the whole limb.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources