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Frostbite in Adult
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Frostbite in Adult

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Contributors: Laurie Good MD, Whitney A. High MD, JD, MEng, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Frostbite is a term describing severe cold injury to the skin, soft tissue, and possibly deeper structures. Exposed areas such as the extremities, chin, cheeks, nose, and ears are most often affected. Typically the cold exposure occurs over minutes or hours, but even instantaneous exposure to cold metal can result in frostbite. At -2°C (28.4°F), cellular metabolism stops, proteins and enzymes are destroyed, and ice crystals form in the extracellular space, causing tissue damage and cell death.

Early symptoms of frostbite include pain and burning. With continued exposure, complete anesthesia will result. Many experts classify frostbite injuries as either superficial or deep, as this corresponds with a functional outcome. For example, if a thumbprint may be left in the skin, the condition is more superficial, while deeper frostbite presents with skin that is hard to the touch. Pain and pruritus associated with frostbite can last as long as 8 weeks and 6 months, respectively.

Predisposing factors for the development of frostbite include vascular conditions (such as peripheral vascular disease), diabetes, and the use of beta blockers. Additionally, peripheral neuropathyand Raynaud phenomenon create a predisposition to frostbite.

Prolonged exposure to cold, moisture, or high winds, restrictive clothing, and alcohol use predispose to frostbite. Prior damage from cold increases the risk of frostbite. Athletes training at high altitude are at increased risk because of the combination of exposure and low ambient oxygen tension, which makes the oxygen deprivation of affected tissues more severe.

Pediatric Patient Considerations:
Children are at increased risk for frostbite because of an inability to communicate symptoms at onset, and because of their increased surface to body mass ratio.

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 the clinical presentation. The differential diagnosis for frostbite includes the following:
  • Frostnip – A form of cold injury that is milder than frostbite, as it involves only the superficial skin and subcutaneous tissue; the pain of frostnip usually resolves within 2-4 weeks.
  • Raynaud phenomenon – A vasospastic disorder, sometimes associated with connective tissue disease, that is characterized by a specific sequence of color changes (white hypovascular skin, followed by cyanotic blue skin, followed by hyperemic red skin).
  • Pernio – A form of cold injury that is associated with a damp or humid environment and results in recurrent painful and/or pruritic, erythematous, violaceous papules or nodules on the fingers and/or toes.
  • Trench foot – A condition affecting the feet that, like pernio, is associated with cold and damp conditions; unlike frostbite, it does not require 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: 09/30/2019
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Frostbite in Adult
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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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