Effects of Cold Temperature on the Skin

  • Kenneth R. Diller
  • Sepideh Khoshnevis
  • Matthew Brothers


The response of skin to the application of surface cooling is manifested primarily as a local vasoconstriction and reduced blood flow. Major functions of skin blood flow (SBF) are to sustain the metabolic process of the skin cells and to facilitate heat transfer between the body core and the environment via the cutaneous circulation. One consequence of surface cooling is to insulate the body core from the environment by reducing the magnitude of SBF. The magnitude of vasoconstriction has a nonlinear dose response to the applied temperature so that even mild cooling can cause the loss of a significant fraction of SBF. Other thermally sensitive processes are also influenced, in particular metabolism, which decreases with falling temperature. So long as a cold state is maintained, both the blood flow and metabolism remain depressed. When the skin is rewarmed, metabolism will likewise increase proportionately. However, in the absence of an externally applied stimulation, the SBF will remain at depressed levels for many hours, presumably due to the action of locally expressed humoral vasomotive agents that block the vasodilation process. The consequences may be prolonged exposure to an ischemic state in conjunction with a high metabolic rate, which may exacerbate the potential for nonfreezing cold injury (NFCI) expressed as tissue necrosis and neuropathy. The decoupling of temperature and SBF during rewarming gives rise to a hysteresis effect that is independent of the speed of the cooling and warming processes.


Cooling Hysteresis Ischemia Nonfreezing cold injury Skin Skin blood flow Temperature Thermoregulation Vasoconstriction 



This research was sponsored by National Science Foundation Grants CBET 0828131, CBET 096998, and CBET 1250659, National Institutes of Health Grant R01 EB015522, and the Robert and Prudie Leibrock Professorship in Engineering at the University of Texas at Austin.

Author Disclosure Statement Patent applications have been submitted by Dr. Diller, Dr. Khoshnevis, and Dr. Brothers to the United States Patent and Trademark Office the cover certain aspects of the technologies discussed herein. Ownership rights to these patents reside with The University of Texas System. Dr. Diller has served as an expert witness for both plaintiff and defendant counsel since 2000 in numerous legal cases regarding the safety and design of existing cryotherapy devices.


  1. 1.
    Johnson JM. Mechanisms of vasoconstriction with direct skin cooling in humans. Am J Physiol Heart Circ Physiol. 2007;292:H1690–1.CrossRefPubMedGoogle Scholar
  2. 2.
    Johnson JM, Kellogg DL. Local thermal control of the human cutaneous circulation. J Appl Physiol. 2010;109:1229–38.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sendowski I, Savourey G, Besnard Y, Bittel J. Cold induced vasodilatation and cardiovascular responses in humans during cold water immersion of various upper limb areas. Eur J Appl Physiol. 1997;75:471–7.CrossRefGoogle Scholar
  4. 4.
    Taber C, Contryman K, Fahrenbruch J, LaCount K, Cornwall MW. Measurement of reactive vasodilation during cold gel pack application to nontraumatized ankles. Phys Ther. 1992;72:294–9.PubMedGoogle Scholar
  5. 5.
    Yanagisawa O, Homma T, Okuwaki T, Shimao D, Takahashi H. Effects of cooling on human skin and skeletal muscle. Eur J Appl Physiol. 2007;100:737–45.CrossRefPubMedGoogle Scholar
  6. 6.
    Francis TJ. Non freezing cold injury: a historical review. J R Nav Med Serv. 1984;70:134–9.PubMedGoogle Scholar
  7. 7.
    Khoshnevis S, Craik NK, Diller KR. Experimental characterization of the domains of coupling and uncoupling between surface temperature and skin blood flow. Intl J Transport Phenom. 2014;13:277–301.Google Scholar
  8. 8.
    Khoshnevis S, Craik NK, Diller KR. Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2475–83.DOI:10.1007/s00167-014-291-y.Google Scholar
  9. 9.
    Jia J, Pollock M. Cold nerve injury is enhanced by intermittent cooling. Muscle Nerve. 1999;22:1644–52.CrossRefPubMedGoogle Scholar
  10. 10.
    Francis TJ, Golden FS. Non-freezing cold injury: the pathogenesis. J R Nav Med Serv. 1985;71:3–8.PubMedGoogle Scholar
  11. 11.
    Thomas JR, Oakley EHN. Nonfreezing cold injury. In: Textbooks of military medicine: medical aspects of harsh environments. Falls Church: Office of the Surgeon General, U. S. Army; 2002. p. 467–90.Google Scholar
  12. 12.
    Brown WC, Hahn DB. Frostbite of the feet after cryotherapy: a report of two cases. J Foot Ankle Surg. 2009;48:577–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee CK, Pardun J, Buntic R, Kiehn M, Brooks D, Buncke HJ. Severe frostbite of the knees after cryotherapy. Orthopedics. 2007;30:63–4.PubMedGoogle Scholar
  14. 14.
    McGuire DA, Hendricks SD. Incidences of frostbite in arthroscopic knee surgery postoperative cryotherapy rehabilitation. J Arthrosc Relat Surg. 2006;22:1141–e1.Google Scholar
  15. 15.
    Large A, Heinbecker P. Nerve degeneration following prolonged cooling of an extremity. Ann Surg. 1944;120:742–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Schaumburg H, Byck R, Herman R, Rosengart C. Peripheral nerve damage by cold. Arch Neurol. 1967;16:103–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Bassett 3rd FH, Kirkpatrick JS, Engelhardt DL, Malone TR. Cryotherapy-induced nerve injury. Am J Sports Med. 1992;20:516–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Irwin MS. Nature and mechanism of peripheral nerve damage in an experimental model of non-freezing cold injury. Ann R Coll Surg Engl. 1996;78:372–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Mazur P. Kinetics of water loss from cells at subzero temperatures and the likelihood of intracellular freezing. J Gen Physiol. 1963;47:347–69.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology. 2002;60(2A):40–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Han B, Bischof JC. Engineering challenges in tissue preservation. Cell Press Technol. 2004;2:91–112.CrossRefGoogle Scholar
  22. 22.
    Balasubramanian SK, Wolkers WF, Bischof JC. Membrane hydration correlates to cellular biophysics during freezing in mammalian cells. Biochim Biophys Acta Biomembr. 2009;1788:945–53.CrossRefGoogle Scholar
  23. 23.
    Roselli RJ, Diller KR, editors. Biotransport: principles and applications. New York: Springer; 2011. 1286 pp.Google Scholar
  24. 24.
    Clough G, Chipperfield A, Byrne C, de Mul F, Gush R. Evaluation of a new high power, wide separation laser Doppler probe: potential measurement of deeper tissue blood flow. Microvasc Res. 2009;78:155–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Kenneth R. Diller
    • 1
  • Sepideh Khoshnevis
    • 1
  • Matthew Brothers
    • 2
  1. 1.Department of Biomedical EngineeringThe University of Texas at AustinAustinUSA
  2. 2.Department of Kinesiology and Health EducationThe University of Texas at AustinAustinUSA

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