Damage to skin and deep tissues caused by extreme and/or prolonged cold.
These are injuries caused by more or less prolonged exposure to the direct action of extreme cold (temperature below 0ºC). Humidity, immersion in water, snow and wind aggravate the effect of the cold and the lesions. It is more frequent in the extremities, nose and ears.
Symptoms include pallor, lack of sensation, swelling, blisters, itching and pain, followed by haemorrhagic blisters, grey or black skin (necrosis) and joint stiffness. It affects skin, muscles, nerves and bones.
Diagnosis is made on the basis of a thorough history and physical examination.
Treatment is based on first warming the body (central heat) and then the frozen area by immersing it in progressively warmer water, analgesics and anti-inflammatory drugs, antiplatelet and/or anticoagulant drugs, antibiotics if there is suspicion of infection and only if there is no response to this treatment, amputation of the frozen limb will be considered.
- Biem J, Koehncke N, Classen D, et al; Out of the cold: management of hypothermia and frostbite. CMAJ. 2003 Feb 4;168(3):305-11.
- Sachs C, Lehnhardt M, Daigeler A, Goertz O. The Triaging and Treatment of Cold-Induced Injuries. Deutsches Ärzteblatt International. 2015;112(44):741-747. doi:10.3238/arztebl.2015.0741.
- Heil K, Thomas R, Robertson G, Porter A, Milner R, Wood A. Br Med Bull. 2016 Mar; 117(1):79-93.
- Ken Zafren, MD, FAAEM, FACEP, FAWM. C Crawford Mechem, MD, FACEP. Frostbite. UPToDate. Apr 20, 2015.
