The specialty of burn care is not relegated to chemical, electrical, flame, and scald injuries. At BRCA, our team of board-certified surgeons and plastic/reconstruction specialists utilize the most advanced treatment and management of cold injuries, including thrombolytic therapy.

What is frostbite?

Cold injuries can result in temporary or permanent tissue damage caused by prolonged exposure to temperatures less than 23°F. Furthermore, injuries can range from frostnip to more complex injuries resulting in significant local tissue loss and limb amputations. The classification of frostbite injuries is similar to burn injuries.

What does frostbite look like?

First-Degree Frostbite Symptoms

  • Numbness.
  • Erythema.
  • White/yellow plaque.
  • Mild skin sloughing.
  • Slight edema.

Second-Degree Frostbite Symptoms

  • Light colored blisters
  • Clear or milky fluid.
  • Erythema surrounds blisters.
  • Subsequent peeling.

Third-Degree Frostbite Symptoms

  • Dark blisters
  • Deep hemorrhagic blister
  • Blisters evolve into thick, black eschar.
  • Injury is to the reticular dermis beneath the dermal vascular plexus.

Fourth-Degree Frostbite Symptoms

  • Injury completely through dermis.
  • Involves subcutaneous tissue.
  • Necrosis to muscle and bone.

What is frostnip?

  • Frostnip is a superficial non-freezing cold injury.
  • It occurs due to severe vasoconstriction of the skin.
  • Ice crystals form on the skin surface as frost.
  • Frostnip does not result in crystals within the tissue or tissue loss.
  • Numbness and pallor of frostnip can be resolved using simple warming.
  • There are typically no long-term effects of frostnip. Still, it can develop into more severe frostbite if not appropriately treated.

What is frostbite and how can it be caused?


  • Limit the amount of time outdoors when temperatures are dangerously low. In freezing, windy weather, exposed skin can develop frostbite in a matter of minutes.
  • Make sure someone knows where you are going and when you should be there in case of an unlikely emergency.
  • Stay hydrated but avoid drinking alcohol if you plan to be out in the cold. Alcoholic beverages can cause you to lose body heat quicker than usual.
  • Dress in several layers of loose, warm clothing, including undergarments that wick moisture away.
  • Make sure your ears and hands are completely covered.

Frostbite Toes

The extremities are more affected by cold exposure than other body parts due to: large surface area to volume ratio, small muscle mass, and a significant reliance on warm blood from the core of the body. Additionally, the feet are often the only parts of the body that constantly contact the ground. Footwear is usually made of impermeable material that does not allow moisture from the outside to make the insulation wet. However, sweat condensation inside of footwear can become a significant problem in cold conditions. Unique drying means should be used for cold weather footwear that has accumulated large amounts of sweat on the inside. Unique socks and insoles can be used for moisture management, which should be changed after heavy activity in cold weather.

Dry ice

Dry ice is solidified carbon dioxide and is much colder than regular ice. Additionally, dry ice burn can damage the skin, cause pain, blisters, numbness, and tingling, and cause symptoms similar to frostbite. Moreover, when dry ice melts, it turns into carbon dioxide gas. Consequently, If not insulated properly, symptoms can include dizziness, headache, nausea, difficulty breathing, and unconsciousness.

When handling dry ice, you should always wear insulated gloves and face and eye protection. Additionally, Dry ice should be kept out of reach of children and should also never be eaten or swallowed. Therefore, dry ice should always be kept in a well-ventilated area. Furthermore, a carbon dioxide detector should be in the vicinity.

What should be avoided if you suspect you have Frostbite?

  • Do not thaw out a frostbitten area as it may cause refreezing. Refreezing may make tissue damage even worse.
  • To thaw the frostbitten areas, avoid using direct dry heat (such as a radiator, campfire, heating pad, or hairdryer). Direct heat can burn the tissues that are already damaged.
  • Refrain from rubbing or massaging the affected area.
  • Make sure you do not disturb blisters on frostbitten skin.
  • To thaw the frostbitten areas, avoid using direct dry heat (such as a radiator, campfire, heating pad, or hairdryer). Direct heat can burn the tissues that are already damaged.
  • Refrain from rubbing or massaging the affected area.
  • Make sure you do not disturb blisters on frostbitten skin.


What is frostbite and how can it be treated?

Urgency is key to improving patient outcomes with frostbite injuries, and time is tissue. 

A better understanding of the pathophysiology of the disease process has led to recent advancements in frostbite treatment. No longer considered a condition of simple tissue freezing, cold injuries are a more complex ailment associated with local tissue injury and vascular occlusion. Today, frostbite treatments attempt to rewarm the affected tissues rapidly while improving blood flow to the injured area with thrombolytics. Additionally, tissue plasminogen activator, commonly known as tPA and given to stroke victims, is a proven, effective treatment for frostbite injuries resulting in significantly lower amputation rates.

Frostbite Treatment

Medical professionals at Burn and Reconstructive Centers of America treat frostbite with thrombolytic therapy. Additionally, if frostbite occurs or you are unsure of the severity of a low-temperature injury, find the nearest facility that offers thrombolytic treatment for frostbite. Moreover, a medical professional may utilize Clot-busting drugs and thaw the frostbitten area with warm water before the need for further intervention is determined.

Patients presenting with frostbite should be viewed as a vascular emergency and immediately seek treatment from a burn specialist trained in the use of tPA. Furthermore, rapid diagnosis and treatment of cold injuries can significantly reduce the morbidity associated with this injury.

When applied rapidly, catheter-directed thrombolytics have been suggested to decrease the likelihood of amputation by 75%*. 

*Source: Bruen KJ. Arch Surg 2007, Jun;142(6):546-51; discussion 551-3. 

Prior to Definitive Care 

  • Evaluate for systemic hypothermia.
  • Rapid, immediate warming of the extremity when there is no risk of refreezing. 
  • Oxygen should be strongly considered. 
  • Apply a topical antibiotic ointment to open wounds. 
  • Blister formation may occur within hours after exposure. Try to avoid breaking the blisters. 
  • Apply a sterile, non-adherent dressing to the affected areas. 
  • Pain treatment as needed based on the patient’s symptoms. 


How long it takes for cases of frostbite in fingers or toes to heal depends on their severity. One of the interesting aspects of frostbite is that dead tissue has been known to heal and recover. The effects of mild frostbite may heal in as little as a few hours without medical intervention or professional frostbite treatment. In many cases, the recovery period of mild to extreme frostbite mirrors that of thermal burns.

Other factors that can play into your recovery time include how quickly you manage to seek treatment, whether you have any underlying conditions like diabetes and the presence of infection. Even if your circulation and feeling in your fingers have returned, it can take months for the visual effects to disappear.

After rewarming treatment, you will notice that your skin will be discolored and blistered. Eventually, it will scab over. Superficial frostbite may appear blue, but new pink skin will form beneath. While this can be an uncomfortable process, it’s completely normal. Most people find that these milder frostbite cases heal in around six months.

In severe cases, debridement or amputation may need to be considered. Naturally, this will significantly increase your recovery time. Speak with your doctor about developing a specific recovery plan for your needs.