Frostbite

Astrid Leitner studied veterinary medicine in Vienna. After ten years in veterinary practice and the birth of her daughter, she switched - more by chance - to medical journalism. It quickly became clear that her interest in medical topics and her love of writing were the perfect combination for her. Astrid Leitner lives with daughter, dog and cat in Vienna and Upper Austria.

More about the experts All content is checked by medical journalists.

Frostbite (congelatio) occurs when the blood circulation in the skin is disturbed for a long time due to the effects of extreme cold. Mostly the nose, cheeks, ears, fingers and toes are affected. Read here how to recognize frostbite and how it is treated!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. T35

Brief overview

What is frostbite ?: The tissue is poorly supplied with blood and damaged due to the strong effects of cold. Depending on the extent of the frostbite, there are three grades.

Symptoms: Depending on the severity of the frostbite: from slight reddening and swelling to skin blisters and pain to tissue death

Treatment: Slow warming of the frozen parts of the body, use only lukewarm (not hot) water. From grade two, treatment takes place in the hospital: warming, medication, wound care (sterile piercing of the blisters, removal of dead tissue, possibly amputation).

Causes: narrowing of the blood vessels due to the cold, insufficient supply of blood and oxygen

Risk factors: Wind, high humidity, too thin, light clothing, alcohol, circulatory disorders, very young or very old age

Diagnostics: typical appearance of frostbite, description of the course of frostbite

Prevention: Clothing and shoes adapted to the temperature, hat, gloves, skin protection, exercise, avoidance of alcohol in the open air

What is Frostbite?

Freezing (congelatio) is localized cold damage to the skin or the underlying tissue. The longer the cold lasts, the more serious the damage. Mostly exposed parts of the body such as cheeks, nose and ears as well as fingers and toes are affected.

In contrast to hypothermia (body temperature below 36 degrees), the internal body temperature remains constant in the event of local frostbite. Superficial frostbite only affects the top layers of the skin and improves after a few minutes when heated again. With deep frostbite, all layers of the skin and the underlying tissue are affected. They can have serious and permanent consequences such as the death of the affected parts of the body.

Classification of frostbite

How severe the frostbite is depends on the following factors:

• Intensity of the cold
• Duration of exposure to cold
• Humidity / wind
• Body protection through clothing and exercise

Frostbite is divided into three grades:

• First degree frostbite: Congelatio erythematosa
• Second degree frostbite: Congelatio bullosa
• Third degree frostbite: Congelatio escharotica

frequency

Frostbite often happens during winter sports and mountaineering. Infants and young children as well as old age adults are particularly at risk because their skin is relatively thin. Drunken homeless people and people who can no longer get up after falling in the cold are often affected by frostbite.

What is cold burn?

By the time local frostbite occurs, the affected body parts have usually already been exposed to cold, wind and high humidity for some time. In the case of cold burns (freezer burn, ice burn, burn from cold), on the other hand, the skin freezes to death in seconds. The cause is sudden contact with extreme cold, such as dry ice, liquid nitrogen or ice packs. The resulting skin damage is roughly equivalent to that of a burn: within a few seconds, sharply defined, pale and dry areas with blistering appear - exactly where the harmful substance came into contact. Within this area, all layers of the skin have died and stuck together within seconds. If the skin is burned by the cold, it will not recover. As a rule, a doctor's visit is absolutely necessary, usually also surgical treatment.

Never put ice packs directly on the skin! Always wrap coolpacks in a towel!

Frostbite

In contrast to hypothermia, in which the body temperature falls below 36 degrees, the core temperature initially remains normal in the case of local frostbite. If the body continues to be exposed to extreme cold, ice crystals form in the cells, which destroy them. If the ice crystals expand over the entire organism, there is a risk of frostbite. People who cannot escape the cold, such as after falling outdoors, are particularly at risk.

The same applies to people who are under the influence of alcohol: Alcohol not only dulls the feeling of cold, it also dilates the blood vessels. As a result, the body cools down even faster, and death from frostbite occurs more quickly.

How do you recognize frostbite?

The symptoms depend on how far the frostbite has progressed. In the case of frostbite, the complaints are limited to the affected areas; General symptoms such as malaise or fever are usually absent.

Symptoms of first degree frostbite

As a result of the cold, the affected area initially becomes cold, pale and insensitive to sensation. As soon as it is warmed up again, it turns red (erythema). The red spots remain even after complete rewarming. When heated, severe itching and possibly burning pain occur, which is due to the resumption of sensitivity. A slight swelling is also noticeable. A first-degree frostbite heals without any consequential damage, but under certain circumstances a slight emotional disorder may persist for years.

Symptoms of second degree frostbite

In the case of deeper skin damage, the skin remains dark red to purple after rewarming. After about 24 hours, one or more blisters will form on the skin. Its content can be clear, but it can also be bloody. The affected area hurts both during and after heating and swells.

Never scratch or prick the blisters yourself as they can develop into an infection!

Symptoms of third degree frostbite

After very intense exposure to the cold, the skin remains pale, cold and numb even after rewarming. The dead areas turn blue-black within a few days (necrosis, mummification).

What to do in case of frostbite

How frostbite is treated depends on its severity. First-degree frostbite can be self-treated and will get better within minutes of being warmed. Second and third degree frostbite requires hospital treatment.

Treatment of first degree frostbite

Mild frostbite usually improves quickly and does not require medical attention. They heal again without any sequelae. However, the affected area may remain sensitive to the cold for years.

How can I treat first degree frostbite?

• Find a dry, sheltered room to prevent renewed or further exposure to the cold.
• Ensure good blood flow to the affected area: If your feet are affected, open shoes that are too tight or remove a ring if your fingers are concerned.
• First, slowly warm the affected area at your own body temperature, for example in the armpit, between the thighs or in the groin area. Frostbite on the face is warmed up with the hands.
• Do not warm the frozen area with hot water or hot baths, as sudden warming increases tissue damage. The water should be at maximum body temperature. You can also put lukewarm compresses on the skin.
• Do not rub or massage the area, this promotes cold damage.
• Never heat the frostbite with direct heat (oven, fire, heating lamp)! There is a risk of burns here.
• Protect the area from freezing again, for example with loose bandages.
• Warm drinks like tea or coffee help to warm up the body internally. But don't drink alcohol

Treatment of second or third degree frostbite

First of all, the doctor determines whether it is local frostbite or hypothermia. If there is also life-threatening hypothermia, this is treated first.

Warming up: First, the frozen area of ​​the skin is slowly warmed up. This is done with warm compresses or a bath at body temperature (maximum 35 degrees).

Medication: To promote internal warming, the doctor will give a warmed infusion through the vein. This may also contain pain relievers. At the same time, the blood vessels are widened with so-called vasodilators, thus promoting blood circulation. Sometimes it is necessary to give blood thinners to reduce the risk of blood clots. Since the frozen tissue is no longer or only poorly supplied with blood, it is very susceptible to infection. The doctor therefore usually also prescribes an antibiotic.

Treatment of blisters: The doctor punctures blisters under sterile conditions and then covers the wound with a wound dressing.

Removal of dead tissue: If the frozen tissue is dead (necrosis), the doctor removes the affected skin area. It can take a few days to several weeks until it can be seen where the boundary between healthy and dead tissue (demarcation line) lies. Therefore, it is possible that the patient will have to wait a few days for the operation. If the affected area is very large, an amputation may be necessary.

Causes and Risk Factors

causes

The cause of frostbite is exposure to cold. So that the body does not get hypothermic in the cold, it tries to keep the internal body temperature (core temperature of about 37 degrees) in balance. This is necessary in order to continue to supply vital organs with blood.

This is done by reducing the heat dissipation through the extremities (arms and legs) and exposed parts of the body (nose, cheeks, ears). To do this, the blood vessels constrict at these points. The vasoconstriction holds the heat in the body, but leads to the fact that the tissue outside the core of the body is insufficiently supplied with blood and oxygen. If countermeasures are not taken in good time, the affected area can die.

Risk factors

Cold is the main cause of frostbite. There are also other risk factors that favor or aggravate the cold damage:

• Long stay outdoors at low outside temperatures (winter sports enthusiasts, mountaineers)
• wind
• High humidity
• Clothing that is too thin, light or constricting
• Damp clothes
• Physical overexertion
• Alcohol consumption
• Blood loss
• smoking
• Diabetes mellitus
• Circulatory disorders
• Malnutrition
• Very young and very old

Investigation and diagnosis

Second and third degree frostbite requires a doctor's visit. Frostbite is usually easy to diagnose: the doctor makes the diagnosis on the basis of typical symptoms and a description of how the cold damage came about. The extent of third-degree frostbite may take days to determine as it takes time for tissue to die. To rule out hypothermia, the doctor measures the internal body temperature.

See a doctor if the frostbite is very painful or blisters form!

prevention

You can prevent frostbite with these tips:

Functional underwear: When it's cold, wear functional or thermal underwear directly on your body. It transfers moisture from the body to the next layer and keeps it warm and dry.

Onion look: Dress appropriately for the temperatures, preferably in an "onion look". Apply several thin layers on top of each other instead of a few thick ones. The air between the individual layers acts as a heat insulator and prevents body heat from escaping.

Dry clothes: If your clothes do get damp, change them immediately!

Shoes: Make sure that your winter shoes are sufficiently wide and well lined.

Hat, gloves: Always wear a hat and gloves in frosty and icy winds! Wear windproof masks in the mountains!

Skin protection: Protect your skin in winter with special cold protection creams! Important: Creams with a high water content can promote frostbite. Instead, use products that are high in fat, such as petroleum jelly! Remember to put lotion on your ears too!

Movement: Always keep moving in icy outside temperatures!

Drink enough: Drink enough, prefer warm drinks to warm the body from the inside. Refrain from alcohol!

Pre-existing conditions: Ask your doctor for advice if you have circulatory problems in your fingers and toes (such as Raynaud's syndrome)!

Caution: Be careful when handling extreme cold (dry ice, liquid nitrogen). Always wrap ice packs in a towel before placing them on your skin.

Course of the disease and prognosis

The course depends on the intensity and extent of the frostbite. Basically, the earlier the frostbite is treated, the better the prognosis.

First and second degree frostbite, if recognized and treated in good time, has a good prognosis. They usually heal without any long-term effects. In some cases, the affected areas remain sensitive to the cold for years. Skin discoloration (skin pigmentation) may remain. From grade three frostbite onwards, scars develop.

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