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C Crawford Mechem, MD, FACEP
Section Editor
Daniel F Danzl, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Frostbite results from the freezing of tissue. It is a disease of morbidity, not mortality. It is most frequently encountered in mountaineers and other cold weather enthusiasts, soldiers, those who work in the cold, the homeless, and individuals stranded outdoors in the winter [1-4]. Among patients with severe frostbite, timely diagnosis and treatment is essential to maximize tissue salvage.

This topic review will discuss the classification, presentation, diagnosis, and management of frostbite. Severe hypothermia, high altitude illness, and other related illnesses are discussed separately. (See "Accidental hypothermia in adults" and "High altitude illness: Physiology, risk factors, and general prevention" and "Acute mountain sickness and high altitude cerebral edema" and "High altitude pulmonary edema" and "High altitude disease: Unique pediatric considerations".)


Frostbite is a severe, localized cold-induced injury due to freezing of tissue. Immersion foot (also referred to as trench foot) is a nonfreezing cold injury (NFCI) that may also cause tissue loss and long-term sequelae. Milder forms of injury include frostnip and pernio:

Frostnip refers to cold-induced, localized paresthesias that resolve with rewarming. There is no permanent tissue damage.

Pernio, or chilblains, is characterized by localized inflammatory lesions that can result from acute or repetitive exposure to damp cold above the freezing point. Lesions are edematous, often reddish or purple, and may be very painful or pruritic (picture 1). Pernio is most common in young women, but both sexes and all age ranges may be affected [5]. Permanent damage from pernio is uncommon, with symptoms and signs generally resolving within two to three weeks.

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Literature review current through: Nov 2017. | This topic last updated: Sep 28, 2017.
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