Frostbite is tissue damage caused by freezing temperatures and constitutes an important cause of morbidity in cold climate zones and high altitude. The direct effects of sub-zero temperatures lead to tissue freezing,
electrolyte shifts and pH alterations, microvascular damage, and eventually to cell death. Upon
rewarming, inflammatory
reperfusion injury and
thrombosis may lead to further tissue damage. Several studies and various case reports show that many patients suffer from long-term sequelae such as vasomotor disturbances (associated with susceptibility to refreezing), and neuropathic and
nociceptive pain, as well as damage to skeletal structures. There are still many uncertainties regarding the pathophysiology of these sequelae. It has been shown that the
transient receptor potential channel (TRP) family plays a role in cold
allodynia.
Botulinum Toxin type A (BTX-A)
injections have been reported to be beneficial in vasomotor and neuropathic disturbances secondary to
frostbite. Epidural sympathetic block has been used for short-term treatment of
frostbite induced
chronic pain. Furthermore,
amitriptyline, gabapentinoids, and
duloxetine may have some benefits.
Frostbite arthritis clinically resembles regular
osteoarthritis. In children there is a risk of epiphyseal cartilage damage leading to bone
deformities. Despite some promising therapeutic concepts, the scarcity of data on
frostbite long-term sequelae in the literature indicates the need of more in-depth studies of this pathology in all its aspects.