From the Guidelines
To treat frostbite, immediately move to a warm environment and seek medical attention as soon as possible, removing wet or tight clothing and jewelry from the affected area, and gently rewarming the frostbitten area by soaking it in warm water at 104-108°F (40-42°C) for 15-30 minutes until the skin becomes soft and sensation returns, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Recommendations
- Remove constricting items such as jewelry and tight clothing to prevent further injury and promote blood flow 1
- Gently rewarm the frostbitten area by soaking it in warm (not hot) water at 104-108°F (40-42°C) for 15-30 minutes until the skin becomes soft and sensation returns, without using direct dry heat like heaters or fires 1
- Take over-the-counter pain medications such as ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) to manage pain during rewarming, which can be intense, as ibuprofen may help prevent further tissue damage and reduce pain 1
- Do not rub, massage, or walk on frostbitten areas as this can cause further tissue damage, and apply sterile bandages between affected fingers or toes to prevent them from sticking together 1
- Elevate the affected limb to reduce swelling, and consider hospital treatment for severe frostbite, including specialized rewarming procedures, medication to restore blood flow, or surgical intervention in cases of tissue death 1
Important Considerations
- Frostbite can occur when skin and underlying tissues freeze due to exposure to extreme cold, causing ice crystal formation within cells that damages tissue and restricts blood flow, which is why proper rewarming and restoration of circulation is critical to minimize permanent damage 1
- In cases of moderate to severe hypothermia, core rewarming should be prioritized before treating frostbite, as rewarming the extremities first can cause the core temperature to decrease 1
From the FDA Drug Label
The efficacy of intravenous (IV) iloprost for the treatment of severe frostbite to reduce the risk of digit amputations is derived from a published open-label, randomized controlled trial that enrolled patients with severe frostbite The trial randomized 47 patients at a single site between 1996 and 2008 At enrollment, all eligible patients (n=47) were treated with rapid rewarming of areas with frostbite, aspirin 250 mg IV, and buflomedil 400 mg IV and then randomized to Groups A, B or C. Group B (n=16) received iloprost IV for 6 hours daily for up to 8 days
- Treatment of severe frostbite: The treatment involves rapid rewarming of the affected areas, aspirin 250 mg IV, and iloprost IV for 6 hours daily for up to 8 days 2.
- Key components:
- Rapid rewarming
- Aspirin 250 mg IV
- Iloprost IV for 6 hours daily for up to 8 days
- The use of iloprost has been shown to reduce the risk of digit amputations in patients with severe frostbite 2.
From the Research
Treatment Options for Frostbite
- Rapid rewarming, aspirin, and buflomedil are commonly used treatments for frostbite, but their effectiveness is unclear 3
- Iloprost, a synthetic prostaglandin analogue, has been shown to reduce the rate of amputations in people with severe frostbite compared to buflomedil alone 3
- The combination of iloprost and recombinant tissue plasminogen activator (rtPA) may also reduce the need for amputation in people with severe frostbite 3
Use of Iloprost in Frostbite Treatment
- Iloprost has been used to treat frostbite due to its vasodilatory properties, which can help to improve blood flow to the affected area 4, 5, 6
- A scoping review of 20 studies found that iloprost may decrease amputation rates in frostbite patients, but more research is needed to confirm its effectiveness 6
Complications of Frostbite
- Acute compartment syndrome is a potential complication of frostbite, which can lead to increased pressure in the affected limb and require urgent surgical intervention 7
- Delayed treatment of frostbite can lead to adverse consequences, including amputation, gangrene, and long-term disability 3, 7