burns 39 (2013) 1024–1030


Letter to the Editor
The challenge of salt and ice
Dear Sir, A nineteen-year-old Caucasian male student was referred to the Welsh Centre for Burns with a three-day-old freezing injury to his left forearm (Fig. 1). The patient presented with three rectangular wounds of superficial partial thickness burns that had been sustained from direct contact with ice cubes and salt as part of a ‘‘Salt and Ice Challenge’’. The Salt and Ice Challenge is a new craze popularized by social media networking sites including ‘‘You Tube’’ and ‘‘Facebook’’ [1–3]. The subject applies salt to their skin and then presses an ice cube onto the salt. The salt melts the ice in an endothermic reaction and ultimately further lowers the temperature at the skin surface. The aim of the challenge is to see how long the subject can withstand the pain of inducing a burn. In our case the patient was under the influence of alcohol and peer pressure when he carried out his 3 attempts. At the time he was unaware of the significance of his actions and the potential harm he was causing himself. He explained that some of his friends had carried out the challenge previously and were keen to see how long he would tolerate the burning. Typing ‘‘Salt and Ice Challenge’’ into Internet search engines, returns many alarming reports of burns sustained while attempting this challenge. The behaviour appears to have originated in USA and many cases are reported in the lay press, the most significant reported injury was sustained by a twelve year old boy in Pittsburg, Pennsylvania, who sustained an approximately 2% total body surface area partial thickness burns in the shape of a crucifix on his back [4–6]. There is, understandably, great concern amongst parental organizations in the USA, however, to the best of our knowledge there have not been any cases reported in the scientific literature [7].

Fortunately our patient’s burns healed with conservative management and we have not seen any other patients with Salt and Ice Challenge burns since.


[1] [2] [3] [4]

https://www.youtube.com/watch?v=PhyzpexhHfY. https://www.youtube.com/watch?v=f9BzuMiQAZA. https://www.youtube.com/watch?v=eNLUDptW-2c. Pittsburgh Post-Gazette Boy, 12, badly injured in ‘salt-andice’ challenge http://www.post-gazette.com/stories/local/ neighborhoods-city/boy-12-badly-injured-in-salt-and-icechallenge-642561. [5] Syracuse girl burned playing Internet fueled game ‘‘Ice and Salt Challenge’’ Central New York News http:// www.cnycentral.com/news/ story.aspx?id=819764#.ULfI_YW3Dbk. [6] Daily Mail ‘‘Boy, 12, burns cross into his back using SALT and ICE after learning about dangerous new craze on YouTube’’ http://www.dailymail.co.uk/news/article-2166905/Boy-12burns-cross-using-SALT-ICE-learning-dangerous-newcraze-YouTube.html. [7] http://www.sheknows.com/parenting/articles/965301/thesalt-and-ice-challenge-dont-let-your-teen-get-burned.

J.M.D. Williams J.J. Cubitt* W.A. Dickson Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea SA6 6NL, United Kingdom *Corresponding author. Tel.: +01792703801 E-mail address: jonathan.cubitt@wales.nhs.uk (J.J. Cubitt) 0305-4179/$36.00 # 2013 Elsevier Ltd and ISBI. All rights reserved. http://dx.doi.org/10.1016/j.burns.2013.01.002

Letter to the Editor
Worrying number of cases of immolation while wearing sheep costumes
Dear Professor Wolf, The authors are concerned by a recent spate of accidental and deliberate immolation of people wearing fancy dress sheep costumes. Our regional Burns Unit has dealt with two such cases in the past two years. One case involved a 24-year-old male who suffered 40% total body surface area (TBSA) burns, and more recently an 18-year-old male who was admitted with 36% TBSA burns. Both required significant reconstructive surgery and a prolonged period of rehabilitation. An internet search for similar cases reveals that since December 2007

Fig. 1 – Left forearm of patient 3 days post salt and ice challenge.

1016/j. with the assailants being given lengthy jail sentences. worryingly the other seven cases were thought to have been set alight deliberately. Three of the ten cases were reportedly accidentally set on fire.1030 burns 39 (2013) 1024–1030 there has been a further six cases reported in the UK. which would require admission to a specialist burns unit or ITU in the more severe cases or those in which there had been smoke inhalation injury. some have been proven as intentional malicious assaults. All rights reserved. which resulted in tragically severe consequences for the victims. http://dx.2013.02. Yours sincerely Stephen J. Livingston. usually cotton wool and glue. The likely morbidity and potential for mortality in these cases was considerable. The authors feel the risk of wearing highly flammable costumes should be better highlighted to the public in order to prevent further such cases.burns.: +44 07711 354288 E-mail address: Stephen_goldie@hotmail. Howden Road West. however.003 *Corresponding .com (S.00 # 2013 Elsevier Ltd and ISBI. All of the victims were dressed in homemade sheep costumes. Scotland. Edinburgh. UK. These ten cases were all involving young males aged 18–35 years of age. However. It is likely that most of these cases began as practical jokes. one in Ireland and one in Milwaukee. Goldie* Daniel Widdowson Hilal Bahia Department of Plastic Surgery. EH3 5BJ. The reported TBSA burned ranged from 12 to 80%. USA.J.org/10. Tel.doi. which essentially entailed covering themselves in extremely flammable material. St John’s Hospital. Scotland. EH54 6PP. UK author at: 58/1 Henderson Row. Goldie) 0305-4179/$36.