Dry ice-induced frostbite injury

Frostbite is a cold thermal injury that occurs when tissues are exposed to temperatures below their freezing point for a sustained period of time. Dry ice or solid carbon dioxide is used as a refrigerant, widely used to transport frozen items. It causes frostbite-like injury, which is managed in the same way as other frostbite injuries. A 24-year-old man presented to us one week after contact with dry ice (Figs 1a, 1b). He had solid carbon dioxide-induced frostbite. Sterile puncturing of the tense blisters, limb elevation and topical steroids with emollients, NSAIDs (non-steroidal anti-inflammatory agents) and oral prednisolone were the treatments advised (Figs 2a–c).

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FIG 1a, 1b.

Dorsal and ventral aspect of involved hands with tense blisters and erythematous base

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FIG 2a, 2b, 2c.

Darkening of the well-defined erythema with flaccid blisters after aspiration on the dorsum and ventral aspect of hands, 1 week after initiation of treatment

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Frostbite causes increased tissue release of arachidonic acid metabolites such as PGE2, PGF2a and thromboxane B2. Hence, NSAIDs have been shown to decrease hospitalization time of patients with frostbite.¹

Local re-warming should begin only if the risk of refreezing has been eliminated. Thawing then refreezing results in more extensive injury.² Hypothermia should be corrected and tetanus prophylaxis is indicated.³ Clear blisters represent superficial injury and require debriding to prevent further contact with mediators in the exudate. Haemorrhagic blisters represent structural damage to the superficial dermal plexus and debridement increases risk of further injury due to desiccation of deeper dermal layers.