Understanding and Managing Frostbite

Lilian White, MD
January 26, 2026

A recent surge of Arctic air has driven temperatures well below seasonal norms across the eastern United States, underscoring the significance of timely recognition and treatment of cold weather injuries. Frostbite is a tissue injury that occurs due to prolonged exposure to low or extreme low temperatures.

The incidence of frostbite is difficult to determine because frostbite lacks a standardized definition. Individuals at increased risk of frostbite include those who are intoxicated, unhoused, older, and military personnel.

In 2024,the Wilderness Medical Society released an update to their frostbite guidelines, building on earlier recommendations reviewed by the AFP Journal. A key principle of treating frostbite is to avoid rewarming the frozen area if there is significant risk of refreezing, which can cause more tissue damage than leaving it frozen. Constricting items (eg, jewelry) should be removed. If moderate or severe hypothermia is also present, treating hypothermia first is recommended to help reduce peripheral vasoconstriction.

Ibuprofen at a dose of 12 mg/kg/day divided twice daily is recommended as soon as possible to reduce vasoconstriction and encourage tissue perfusion. Ongoing treatment is recommended until the wound is healed. Oxygen by nasal cannula may be considered at high altitudes (> 13,000 ft) and in patients with hypoxemia, but hyperoxia may be harmful and should be avoided because it leads to peripheral vasoconstriction.

If definitive care is more than 2 hours away and refreezing can be prevented, the area of frostbite may be rapidly rewarmed by placing it in water heated to 98.6°F to 102.2°F (37°C to 39°C). If a thermometer is not available, another uninjured extremity may be used, and if the water feels tolerable or comfortable for at least 30 seconds, it is likely safe to use.

Edema is a common sequela of rewarming that can be reduced by elevating the area of frostbite above the level of the heart. Tissue reperfusion may also cause compartment syndrome. Air drying is recommended to reduce friction and further wound damage. Topical aloe vera improves wound outcomes. Bulky gauze dressings are then applied to prevent infection and treat edema. Wound dressings may be changed every 6 hours.

Debridement of blisters and antibiotic prophylaxis are generally not needed. Prophylaxis for tetanus is recommended according to usual wound care. If a lower extremity is affected (unless limited to distal toes), ambulation using that extremity should be avoided.

The Cauchy classification (Table 1) is used to grade frostbite by severity following rewarming to guide the need for amputation. Thrombolytic and iloprost therapy may be considered for deep frostbite within 24 and 48 hours, respectively. The full extent of tissue damage often takes 1 to 3 months. Bone scan or angiography may be used to help assess the extent of tissue damage. If possible, amputation should not be considered until 1 to 3 months postinjury in consultation with a surgeon who has experience treating frostbite.

Additional information on cold weather injuries may be found in an AFP article on hypothermia and cold weather injuries.