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Frostbite - Skin
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Frostbite - Skin

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Contributors: Paul Kelly MD, Lowell A. Goldsmith MD, MPH, Lynn McKinley-Grant MD, Aída Lugo-Somolinos MD
Other Resources UpToDate PubMed

Synopsis

Frostbite is a localized cold injury to the skin, soft tissue, and deeper structures in severe cases. This tissue injury is the result of exposure to temperatures below the freezing point 0°C (32°F). Blood vessels near the skin initially respond by vasoconstricting to help preserve core body temperature. Pathogenesis is related to local, cold-induced crystallization of tissue water into ice that causes hypoxia, release of inflammatory mediators, and ultimately tissue damage and cell death. The extremities, chin, nose, ears and cheeks are most affected. Indirect damage such as thrombosis or vasodilation may also occur. Frostbite typically occurs over extended cold exposure (minutes or hours) but may also result from instantaneous exposure to cold metal.

Early symptoms of frostbite include loss of pain sensation or a burning/tingling sensation. Complete anesthesia may occur with continued exposure. Clinical features of frostbite include cellular tissue effects (eg, endothelial injury and membrane damage), a thermoregulatory response (eg, shivering), and a systemic response (eg, shock, neuromuscular dysfunction). There are two clinical presentations: superficial frostbite and deep frostbite. Deep frostbite involves subcutaneous tissue and most often leads to tissue loss.

Young, elderly, and intoxicated persons are most at risk for frostbite. Research has shown that African American men and women are slightly more prone to develop frostbite than whites. Other people who may be more predisposed to frostbite are those of Arabic descent and those who reside in warmer climates. Men develop frostbite more often than women, but this may reflect a greater participation in sports and outdoor activities and a higher number of men who are homeless; athletes in cold climates and homeless persons without adequate shelter or clothing are at-risk populations for frostbite. Diabetes, the use of beta blockers, Raynaud's phenomenon and peripheral neuropathy may also predispose to frostbite development .

Pediatric Patient Considerations:
Infants and children have an increased susceptibility to frostbite because they lose heat from their skin faster because of their increased surface-to-body mass ratio. Often times, children may not communicate their symptoms at early onset.

Codes

ICD10CM:
T33.90XA – Superficial frostbite of unspecified sites, initial encounter

SNOMEDCT:
370977006 – Frostbite

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

A diagnosis of frostbite is usually made based on a history of cold exposure and clinical presentation. Make sure to consider the following differential diagnoses:
  • Frostnip – A milder form of cold injury that only involves the superficial and subcutaneous tissue. Pain usually resolves in 2 to 4 weeks.
  • Pernio – A form of cold injury associated with damp or humid environment. Look for recurrent painful and/or pruritic erythematous, violaceous papules on fingers and/or toes. Often seen with poor vascular circulation.
  • Trench foot – A condition affecting the feet that is associated with damp and cold environments. Unlike frostbite, it does not require exposure to freezing temperatures.
  • Bullous pemphigoid – Look for systemic, tense, and intensely pruritic blisters.
  • Cocaine levamisole toxicity

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 05/21/2015
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Frostbite - Skin
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Frostbite : Cold exposure, Cyanosis, Dusky color, Ear, Fingers, Nose, Painful skin lesions, Toes
Clinical image of Frostbite
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