Therapeutic recommendations for frostbite: A narrative overview

Background: Frostbite is a localized cold injury resulting from tissue freezing, primarily affecting the extremities. Although rare in the general population, it is more frequent among individuals exposed to extreme cold, such as soldiers and mountaineers. Severe cases can result in permanent disability and tissue loss. Objective: To provide a narrative overview of current evidence-based recommendations for the prevention and treatment of frostbite, based primarily on recent guideline updates from the Wilderness Medical Society (2024) and the American Burn Association (2024).Methods: This narrative review summarizes and compares recommendations from two major clinical guideline publications, supplemented by supporting literature. No systematic literature search or meta-analysis was conducted. Results: Immediate management focuses on protecting the patient from further cold exposure, treating hypothermia, and rapidly rewarming affected areas in a warm water bath (37–39°C), followed by sterile wound care, possible blister management, splinting (immobilisation) and rapid hospital transport. Ibuprofen is recommended early for its anti-inflammatory and antiplatelet effects. In hospital settings, treatment includes rapid rewarming (if not yet applied), sterile wound care, analgesia, hydration, and tetanus prophylaxis. Thrombolytic therapy with rt-PA within 24 hours of rewarming may reduce amputation rates in deep frostbite. Iloprost is recommended as first-line therapy for grade 3–4 injuries, particularly when thrombolysis is contraindicated. Antibiotics are reserved for confirmed infection. Conclusions: Frostbite results from prolonged cold exposure, causing ice crystal formation, microvascular injury, inflammation, and ischemia. Early recognition and rapid, controlled rewarming, pain management, and immobilization are essential. Hospital care includes severity assessment, pharmacologic therapy (ibuprofen, thrombolytics, iloprost, anticoagulants), selective blister management, and supportive measures. Timely intervention reduces tissue loss, prevents progression to necrosis, and improves functional outcomes.