Why do chilblains have to stay extremely dry

FrostbiteIndications Frostbite usually occurs in exposed areas such as the hands, feet and head. The tissue freezes, becomes pale and insensitive to touch. Only when thawing do you experience severe pain and, depending on the severity, blisters, swellings and necroses form. Frostbite is thawed with warm water under medical treatment and adequately treated. Painkillers, among other things, are used for drug treatment.

synonymous: congelatio, cold damage


With local frostbite, the skin becomes pale, cold, hard and insensitive to touch and pain. Only when warming up and thawing does reddening appear and strong, pulsating pain, a burning sensation and tingling occur. In addition, edema and blisters can form, and if the course is severe, tissue dies. Exposed parts of the body such as the face, ears, nose, hands and feet are often affected. Like burns, frostbite can be divided into different degrees of severity. Today it is also common to classify it according to the depth and type of bubbles (clear or bloody). It can only be done after thawing, as the frostbite looks similar beforehand.


  • 1st degree: redness, hyperemia and swelling, no blisters or necrosis
  • 2nd degree: Severe edema, hyperemia, blistering (clear liquid)


  • 3rd degree: Subcutaneous frostbite, violet-bloody blisters, skin necrosis, blue-gray discoloration
  • 4th degree: The tissue, muscles, tendons and bones freeze, slight edema, deep red, later dry to black discolored, tissue loss

The complications can range from mild to severe. Pain and sensory disturbances such as throbbing, tingling, electric shocks or an increased sensitivity to cold can persist for weeks to years. Frostbite can lead to severe skin and tissue damage, which can make it necessary to amputate entire limbs.


Local frostbite is not just hypothermia, the tissue actually freezes; ice crystals form. On the one hand, because of the constriction of the blood vessels, cold leads to an insufficient supply of the tissue with blood and oxygen (hypoxia, ischemia). Blood circulation is also obstructed by clots. On the other hand, the extracellular water crystallizes, which causes an osmotic imbalance, dehydrates and damages the cells and leads to cell death. Ice crystals also damage the cells mechanically.

Risk factors
  • Low temperatures, wind, moisture, water
  • Clothes that are too light in a cold environment
  • Profession, for example military service
  • Leisure activities such as skiing, mountaineering, hiking
  • Middle age (leisure activities)
  • homelessness
  • Mental impairment, for example through alcohol consumption, intoxicants, medication, trauma, dementia or mental illness. Alcohol also dilates the blood vessels and inhibits tremors, which leads to a loss of heat.
  • Accidents, such as a car accident or an avalanche accident
  • Vascular diseases, circulatory disorders, neuropathy
  • Tight clothes
  • Smoking: nicotine
  • Medicines: vasoconstrictors, beta blockers
Diagnosis and differential diagnoses

Frostbite is not a frostbite, but an inflammatory skin reaction to cold temperatures and a humid climate (see there). Diseases that cause skin blisters can be mistaken for frostbite, such as burns, insect bites, herpes simplex, impetigo or pemphigus vulgaris.

  • Clothing adapted to the environmental conditions, protection against cold, wind and water
  • Keep dry
  • Do not constrict the extremities with clothes that are too tight
  • Eat and drink enough food, avoid dehydration

It is controversial whether anhydrous ointments, as traditionally used in Finland, help protect against the cold. It is possible that, on the contrary, they are even a risk factor for frostbite.


If frostbite is suspected, patients should seek medical attention as soon as possible out of the cold. Basically, the frostbite should be thawed again as soon as possible. It must be ensured that once thawed tissue does not freeze again later, otherwise it will die (!) Wet and cold clothes should be changed. The frozen areas should not be rubbed, as was previously recommended, as this would further worsen the tissue damage.

In medical treatment, frozen tissue is quickly thawed with warm water (37-42 ° C) with the addition of disinfectants such as octenidine. Antibiotics are used to treat infections, painkillers such as opioids are used to treat severe pain. Non-steroidal anti-inflammatory drugs like ibuprofen are anti-inflammatory. In addition, other drugs such as antithrombotics, vasodilators and vaccinations (tetanus) are used; for the exact procedure, we refer to the specialist literature. The wounds are professionally cared for and debridement may be carried out.

If medical help is not available in an emergency, the tissue can also be thawed yourself, for example by holding it under the armpits of another person or, as in medical treatment, with a warm water bath. No direct and hot source of heat should be used (e.g. hair dryer, fire), as the skin is heated too much and burns occur. It is normal for local swelling, redness and possibly blistering to appear during and after thawing. Rings, tight clothes and shoes should therefore be removed before thawing. Elevating the limb reduces edema formation. Take pain relievers such as ibuprofen or another NSAID in high enough doses for analgesia.

see also


  • Medicinal product information (CH)
  • Biedermann H. Diagnosis and therapy of local frostbite. Intensivmed, 2002, 39, 306-310
  • Biem J., Koehncke N., Classen D., Dosman J. Out of the cold: management of hypothermia and frostbite. CMAJ, 2003, 168 (3), 305-11 Pubmed
  • Goertz O. et al. Three case reports of frostbite. Management and Literature. Trauma surgeon, 2010, 1-5
  • Hallam M.J., Cubison T., Dheansa B., Imray C. Managing frostbite. BMJ, 2010, 19, 341, c5864 Pubmed
  • Imray C., Grieve A., Dhillon S. Caudwell Xtreme Everest Research Group. Cold damage to the extremities: frostbite and non-freezing cold injuries. Postgrad Med J, 2009, 85 (1007), 481-8 Pubmed
  • McCauley R.L. et al. Frostbite injuries: a rational approach based on the pathophysiology. J Trauma, 1983, 23 (2), 143-7 Pubmed
  • Morton P.M., Kummerfeldt P.M. Wilderness survival. Emerg Med Clin North Am, 2004, 22 (2), 475-509
  • Murphy J.V., Banwell P.E., Roberts A.H., McGrouther D.A. Frostbite: pathogenesis and treatment. J Trauma, 2000, 48 (1), 171-8 Pubmed
  • Patel N.N., Patel D.N. Frostbite. Am J Med, 2008, 121 (9), 765-6 Pubmed
  • Roche-Nagle G., Murphy D., Collins A., Sheehan S. Frostbite: management options. Eur J Emerg Med, 2008, 15 (3), 173-5 Pubmed
  • Ulrich A.S., Rathlev N.K. Hypothermia and localized cold injuries. Emerg Med Clin North Am, 2004, 22 (2), 281-98 Pubmed
  • MedlinePlus

Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.

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