Bréhin Camille, Cortey Caroline, Claudet Isabelle
From the Pediatric Emergency Department, Children Hospital, Centre Hospitalier Universitaire Toulouse.
Pediatr Emerg Care. 2021 Feb 1;37(2):e81-e83. doi: 10.1097/PEC.0000000000001722.
We report a case of geometrical skin lesions in a teenage patient.
A previously healthy 14-year-old boy presented in our pediatric emergency department with unusual skin lesions on his left forearm. The patient said the lesions started 2 weeks earlier following a spider bite. His physical examination revealed an otherwise healthy child with no medical history with raised square lesions of the left forearm. The lesions were in different stages of healing and resembled second-degree burns. Examination showed no other lesions. Vital signs were normal. The patient was discharged after the lesions were dressed with antibiotic ointment. A follow-up consultation was scheduled a week later, but the patient did not attend the follow-up consultation. A senior emergency physician called the family and learned that the lesions were progressively healing and no other lesions appeared. The teen admitted he played the "salt and ice challenge."
The salt and ice challenge involves putting salt on the skin and then applying and/or pressing ice cubes on top of the salt. The challenge is to resist the pain consecutive to frostbite for as long as possible. The result is often second-degree burns and possible partial third-degree burns.
Because of the current popularity of this practice, emergency or family physicians, pediatricians, dermatologists, and burn or orthopedic surgery units might encounter these injuries. When young patients present with geometrical burn injuries and unexplained or bizarre circumstances, self-inflicted burn "challenges" should be considered.
我们报告一例青少年患者出现的几何形状皮肤损伤病例。
一名此前健康的14岁男孩因左前臂出现异常皮肤损伤到我们的儿科急诊科就诊。患者称损伤始于2周前被蜘蛛叮咬之后。体格检查显示该儿童身体健康，无病史，左前臂有凸起的方形损伤。损伤处于不同的愈合阶段，类似二度烧伤。检查未发现其他损伤。生命体征正常。损伤处涂抹抗生素软膏后患者出院。一周后安排了随访会诊，但患者未参加。一名资深急诊科医生致电患者家属，得知损伤在逐渐愈合，未出现其他损伤。该青少年承认他参与了“盐冰挑战”。
盐冰挑战包括将盐涂在皮肤上，然后在盐上面放置和/或按压冰块。挑战的内容是尽可能长时间忍受冻伤带来的疼痛。结果往往是二度烧伤，甚至可能是部分三度烧伤。
鉴于这种行为目前很流行，急诊科或家庭医生、儿科医生、皮肤科医生以及烧伤或整形外科科室可能会遇到此类损伤。当年轻患者出现几何形状的烧伤且情况不明或怪异时，应考虑自伤性烧伤“挑战”。
