This article is more than 5 years old. Information may no longer be current.
Awareness of social trends aids diagnose of suspicious lesion
Click Here to Manage Email Alerts
A 13-year-old, right-handed male presents for evaluation of nevi when a suspicious lesion is noted on his left forearm. The patient reports that he developed a blistering rash in this area a month before presentation. He does not have blisters or similar lesions on other parts of his body. He denies applying any new skin care products to this area. He is not taking any medications.
Shehla Admani
Andrew C. Krakowski
On physical exam, the patient is noted to have a hyper- and hypopigmented plaque with a central atrophic, erythematous scar on his left forearm. The lesion is not tender to palpation. There is no evidence of a “drip” or “splatter” pattern of injury. There is no local lymphadenopathy, and there are no other signs of systemic illness.
What is the most likely cause of the patient’s skin lesion?
A. Phytophotodermatitis
B. Fixed drug eruption
C. Factitial/self-induced dermatitis
D. Deep fungal infection
E. Bullous impetigo
Hint: He proudly admits that he is the reigning “eraser challenge” champion at his local junior high school.
Can you spot the rash?
Factitial/self-induced dermatitis
Upon further questioning, the patient admits to participating in the “salt and ice challenge,” in which he was dared to apply salt to his left forearm and then press an ice cube onto this area. The salt and ice challenge causes a reaction that drops the temperature below freezing and induces a thermal burn. The winner of the challenge is the person who can tolerate the burn the longest.
There have been several cases of this challenge on social media and YouTube. The self-induced behavior may result in second-degree burns and in eruptions that can appear clinically similar to other bullous dermatoses. Clinical clues include the age and handedness of the patient and the location of the injury (ie, the nondominant forearm).
Hyper- and hypopigmented plaque with a central atrophic, erythematous scar on patient’s left forearm.
Source: Krakowski AC
Likewise, these challenges may come in mini-epidemics that sweep through a region, so other patients may have recently presented with similar lesions. A variant is the eraser challenge, in which an eraser is vigorously rubbed on the skin until it erodes and the participant can no longer withstand the pain.
As the adolescent patient may not admit to creating a self-inflicted burn, it is important for the practitioner to be aware of the latest trends occurring among school-aged children.
Deklotz CM. J Clin Aesthet Dermatol. 2013;6:45-46.
Williams JM. Burns. 2013;doi:10.1016/j.burns.2013.01.002.
Zack JM. Pediatr Dermatol. 2014;31:252-254.
Shehla Admani, MD, is a clinical research fellow in pediatric dermatology at Rady Children’s Hospital, San Diego. She can be reached at 8010 Frost St., Suite 602, San Diego, CA 92123; email: sadmani@rchsd.org.
Andrew C. Krakowski, MD, is an attending physician at Rady Children’s Hospital, San Diego.
Disclosure: Admani and Krakowski report no relevant financial disclosures.