How to Avoid Frostbite From an Ice Pack

Frostbite from an ice pack can occur if you leave an ice pack on your injury for too long or if you place it directly on your skin. While ice packs are helpful, and experts often recommend using ice to soothe pain, inflammation, and swelling, you want to take care to avoid ice burn.

Here's what to know about how ice packs can cause burns and how to use ice on injuries safely.

How Ice Packs Cause Burns

Water freezes at 32 degrees Fahrenheit, but the ice that comes out of the freezer is likely to be much colder than that. Putting ice or any kind of chemical cold pack—homemade or otherwise—directly on the skin can lead to frostbite in minutes.

Ice crystals form in the skin cells and blood flow slows, depriving the tissues of oxygen. As it progresses, the ice burn causes permanent damage to your skin and underlying tissues. In severe cases, it can lead to gangrene (tissue death) and amputation.

Risk Factors for Ice Burns

Certain situations, such as a history of underlying health conditions or frostbite exposures at work, can increase the risk of an ice burn. For example, people with poor circulation (as with Raynaud's syndrome) may not respond as well to ice pack use.

In some people, the syndrome itself is linked to a thyroid disorder, which may contribute to risk. Other risk factors that can lead to poor circulation and ice burns may include:

• Previous injuries or surgeries at the site
• Use of certain medications, including over-the-counter drugs
• Autoimmune conditions, such as lupus or rheumatoid arthritis

People who have a history of smoking, or who were assigned female at birth, also may be more at risk.

How to Prevent Ice Burns

When you use an ice pack, pay attention to how your skin feels. The first stage of ice burn is known as frostnip. Frostnip causes your skin to get red or pale with a tingling and prickly sensation. It’s a sign that you should remove the ice pack and warm the area so you don't damage your skin.

It can be helpful to use the acronym “CBAN,” which stands for cold, burn, ache, and numb. These are four sensations you feel when your skin is exposed to ice for too long.

• Cold: First, you’ll notice the cold
• Burn: Soon after you’ll feel a burning sensation 
• Ache: After a few minutes, you may notice that the area feels achy before the skin finally feels numb
• Numb: As soon as you feel any numbness, remove the ice to avoid causing ice burn

Don’t put ice or ice packs directly on the skin. A plastic bag isn’t enough to protect your skin from ice burn. You should always wrap the ice in a towel or other thin cloth. 

Make sure to watch the clock. You should ice an injury for 20 minutes at a time. Studies have found that this offers the greatest benefit in reducing pain while limiting any numbness, burning, and redness.

A good rule of thumb is 20 minutes on followed by 20 minutes off. Never fall asleep with an ice pack on your skin.

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What Does Frostbite Look Like?

Frostbite from an ice pack will, at first, look just like a burn. Symptoms include:

• Swelling
• Skin blisters
• Red and then yellow or white skin at the site

As your symptoms progress, the skin may become more white, blue, or even black in the later stages (though it's unlikely that ice pack use will cause skin changes common to environmental exposure).

Healthcare providers classify the severity of burns due to frostbite when treating these injuries. These frostbite burns range from a category I to IV, with more severity the higher the number:

• Class I burns show some skin redness, with numbness
• Class II burns reflect increasing damage, with blisters, swelling, and peeling skin
• Class III burns have more advanced damage, with peeling and dead tissue
• Class IV burns show blackened, dead skin, often infected, that may lead to amputation

When You Shouldn't Use Ice

Don’t use ice on your skin if it already feels numb. When your skin is numb or tingly, you may not be able to tell when the ice is causing damage.

Also, don’t use an ice pack on an area that’s already injured with a blister or burn. When the skin is already damaged, you are more likely to develop an ice burn. 

How to Treat Frostbite From an Ice Pack

Remove the ice pack. Soak the affected area in warm water, making sure the water is comfortable and not hot, for 30 minutes or less. Gently wash and dry the area and wrap in a sterile bandage. Do not rub your skin—it can cause further damage if you have frostbite. Seek medical care if you have signs of frostbite.

Mild ice burns may take a few days to heal, but it will vary based on the degree of injury. Deep, severe burns can take months and may require surgery to remove dead skin and tissue.The severity also is made worse if more of the body is affected, rather than an isolated location more typical of ice pack use.

When to See a Healthcare Provider

Certain medical conditions, such as vascular disease and diabetes, may make your tissues more likely to be damaged with ice burn. If you have questions about your risk for frostbite, speak to your healthcare provider about whether it’s safe for you to ice your injury.

If ice packs aren't working, or if you think they've added a new frostnip or frostbite injury, it may be time to see your provider for a diagnosis and treatment.

Summary

Frostbite from an ice pack may be a rare injury, but it is possible in people who have an increased risk of tissue damage or simply aren't using the right technique to protect skin. Ice packs can be helpful but never leave them on the skin for more than 20 minutes at a time.

You also may wish to carefully consider their use in people who have an underlying health issue that affects their ability to sense pain and cold, or who have circulatory conditions that affect their responses.

In most cases, skin damage from an ice pack is comparatively mild and can be treated at home. Severe frostbite cases typically require hospitalization with long recovery times and, in some cases, permanent damage.