In the latest installment of our conversations with Fort Worth newsmakers, Dr. Timothy Niacaris, hand and upper extremity surgeon with Texas Health Hand and Upper Extremity Specialists, discusses frostnip, frostbite and how to prevent them both. 

This conversation has been edited for length and clarity. For a longer version, please listen to the audio file attached to this article.

Alexis Allison: So Dr. Niacaris, what is frostbite?

Dr. Timothy Niacaris: Frostbite, simply speaking, is just when certain parts of the body that are susceptible get very cold and in the most extreme sense can even freeze. And this is typically fingers, toes, nose and ears. And it’s typically when people are exposed to the cold, especially without protection.

Allison: So when these areas get especially cold or freeze, what are some of the possible consequences?

Niacaris: Well, the consequences can be devastating — up to amputation of the various parts. People can lose fingers or any of the parts that we mentioned due to frostbite.

Allison: Can you tell us about the context of frostbite? Like, how long does it take to get frostbite? And at what temperature?

Niacaris: People have asked me that all the time. And the reality is, there is really no specific temperature or time. It’s a combination. I like to use analogies all the time, Alexis, and I think of it like cooking a roast: How long does it take you to cook a roast? Well, it depends on the temperature and the time. And so with frostbite, it’s similar in the sense that the colder it is, the less time it takes to have symptoms. And the other thing is, kind of like cooking your roast from rare to well done, frostbite has stages as well. And some of the very early stages can be common and reversible. And some of the later stages can be devastating and irreversible.

Allison: Can we talk about the stages a little bit more and how to reverse the earlier stages?

Niacaris: Sure. So the first stage, which probably everybody has experienced at one point if they’ve ever traveled or been in cold weather, is frostnip. Frostnip is when you get that feeling in your fingers of incredible cold and you start getting tingly, where you know your hands, or any other part of your body that we mentioned, are getting too cold. And at this date, the fingers, which is what I focus on, can look either red or even start to turn white. And frostnip is where there really isn’t any tissue damage, but your body is starting to sense that there’s a potential for damage. At this stage, if you simply remove that part of your body from the cold or protect it, it can be completely reversible. 

Now beyond that, we go to frostbite. And while there are several medical stages of frostbite, it’s usually simple to think of it in two terms: superficial or deep, and superficial frostbite is the type of frostbite where there will be consequences, meaning your skin can slough off, and you could get blistering, but the deep underlying tissues don’t get affected to the point where that tissue can’t regenerate. With deeper frostbite, the tissues that would regenerate get so negatively affected that they can’t. And that’s the serious stages, where you could have loss of tissue and even an amputation.

Allison: How can people protect against any of these stages?

Niacaris: Well, the simplest thing is to protect yourself from the elements when you’re going to be in cold weather. And to be a little bit more specific — what is considered cold? You’re at risk for frostnip and frostbite at temperatures even 35 degrees and below with prolonged exposure without appropriate protection. So it doesn’t even have to be freezing outside to have these stages start to occur, especially frostnip. Windchill, hands being wet, or other parts of your body being wet can make this happen at higher temperatures or lower times. 

You’re at risk for frostnip and frostbite at temperatures even 35 degrees and below with prolonged exposure without appropriate protection. So it doesn’t even have to be freezing outside.

Dr. Timothy Niacaris

I mean, everybody is aware how windchill can really change how the body feels in a certain temperature, so that affects frostbite as well. Another thing that doesn’t get enough attention is, your core body temperature and being warm all over your body affects frostbite. And that’s because, when your body is cold, it tries to shunt your blood from the sensitive areas we talked about — the fingers, the nose, toes and ears — to the central part of the body to keep you warm. So staying warm throughout your body, wearing a coat, a hat, can also help with the development of frostbite.

Allison: Who is most susceptible to frostbite?

Niacaris: You know, that’s a great question. There’s been several studies on the demographics of who gets frostbite and it gets really complicated. The most common age range or the most common characteristic of an individual with frostbite is males between 30s and 40s. But the reason is, it’s thought to be due to work-related injuries and activities and hobbies that put them at risk. 

However, the most susceptible people are young children who weren’t protected and often people that are homeless or don’t have the ability to protect themselves from a cold. So there’s kind of this split thought in terms of those that can’t protect themselves and those that are putting themselves in an environment that is more likely to have it occur.

Allison: For those different groups, what would you recommend that they do if they start to develop frostbite? 

Niacaris: Well, the simple thing is to protect and warm. Those are the two things that can be done in those situations. So, if you feel those first signs of frostnip, which are the tingling sensation and the feelings of cold, that’s your body warning you that you’re putting yourself at risk, and that’s a good time to warm yourself up. Avoid the exposure, if at all possible. But specifically to seek shelter from wind, keep your extremities and hands and face dry and covered. 

Allison: What’s the signal that you are entering frostbite after frostnip?

Niacaris: Well believe it or not, the cold and pain and tingling can go away. And that’s one of the things that’s most concerning, because once you enter the stages of frostbite, the symptoms become numbness and the pain and discomfort you feel and the feelings of cold can actually subside. A completely frozen, frostbitten extremity is not exactly painful. And we can go into some of the consequences when we treat frostbite related to that, but once your hands are numb and firm and rigid feeling, you can get weakness and clumsiness, because the muscles start to dysfunction. Once you’ve reached that stage, you’re really beyond the early reversible effects of frostnip and you’re into frostbite.

Allison: So once that happens, what do you recommend that people do?

Niacaris: Well, what you should do really depends. It depends on where you’re at in this process and what your resources are. The simplest thing to say is, you want to avoid exposure and begin rewarming. 

When you rewarm an extremity that is suffering frostbite, you have to make sure that the water is not hot at all. It’s really supposed to be body temperature or just above. And the reason for that is, the tissue is already susceptible to injury, and it can actually have a thermal burn very easily. So you want to make sure that, in the attempt to rewarm, you don’t cause injury in terms of a burn. And that can be heating pads, electric blankets, putting their hands near a heat source. 

The most effective way is to first address the central body temperature by making sure that, either by drinking more fluids or using warm IV fluids, the core temperature is helping prevent the body from taking the blood away from the hands and then rewarming the hands or feet in a water bath that’s about body temperature. 

Now, I think the more challenging environment is what happens when you’re in the wilderness or you’re in a car that got stuck and now you have frostbite. What do you do in that situation? Well, that gets very complicated, because the one rule of thumb that I can say is, if you can’t guarantee that the extremity is going to stay warm, don’t rewarm it, because refreezing is just as dangerous as the initial frostbite and can even be more so. 

If you’re in a situation where you don’t have access to a lot of resources, what you can do is use your central body heat to try to keep the extremity as warm as possible. And that’s placing, especially if it’s your hands, in your armpits, covering everything you can with the higher sources of heat along your body.

Allison: At what point does someone need to go see a provider?

Niacaris: Well, when your tissue becomes white and it’s numb, especially if you see any signs of blistering, I think you’re beyond where they should be treated at home. I think if you’re in the early stages of frostnip, where your fingers seem a little bit red, but you can still feel them and they’re tingly, that’s clearly something where you can try to mitigate it on your own. Once you have numbness, any kind of blistering, you should seek medical attention, because those blisters can become infected and further complicate your healing process.

Allison: What can someone do if they see someone else, say, on the street, who may be in danger of developing frostbite?

Niacaris: Well, I think the important thing is to remember those people in situations where they can’t protect themselves. We go beyond the concerns for frostbite. Cold weather exposure, especially when you’re not adequately protected, can be life-threatening. So, certainly I would do everything you can to try to use the resources you have to get those individuals to shelter and if you don’t, you should contact the authorities because again, this is not just a situation of frostbite but life or death in those circumstances.

Want text alerts about cold-weather shelters?

To receive text alerts about Fort Worth cold-weather shelters, text FWCOLD to 817-241-3544.

To receive text alerts about Arlington cold-weather shelters, text ARLCOLD to 817-241-3544.

For more information about shelters in Tarrant County, visit the Tarrant County Homeless Coalition’s website.

Allison: Thank you so much for this information. Is there anything else that you’d like to add?

Niacaris: Well, I think the only thing that I would like to add is, just because we’re in Texas doesn’t mean it can’t happen. I see frostbite victims all the time. I grew up in Chicago, but I’ve been practicing in Texas for the past 10 years, and the reality is, people in colder climates are more likely to be protected. 

When we had the great freeze, for example, in Texas a few years ago, people just weren’t prepared for this type of climate. Kids will often want to go out and play in the snow and may not have the appropriate gloves to do so, and in susceptible people, frostnip and eventually frostbite can happen quicker than you might think. So it’s one of those things that, sometimes being in a warm environment can make you even more predisposed to having these things happen without being fully aware of what the consequences are.

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her at or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....