A local case of the "salt-and-ice challenge," as popularized on YouTube and even Facebook, occurred June 23 when a 12-year-old Pittsburgh boy's twin brother and friend put salt in a cross formation on his back, then applied ice and pressure.
Pain from melting ice and salt occurs in just moments with the ill-advised goal of seeing how long the person can tolerate the pain. The local youth withstood the challenge long enough to require treatment the next day in the West Penn Hospital emergency room in Bloomfield then a return trip Monday to the hospital's burn center.
Although a doctor said the second-degree "cold injury" likely would not cause scarring, the healing process could take months with the help of a prescribed drug and salve that the boy's mother must put on the injury four times a day for the rest of the summer. She also must peel off the dead skin, and he can't swim or expose his back to the sun. Whenever he sweats, his back must be washed.
The severity of the injury has prompted burn center director Ariel Aballay to warn parents and the public during a Friday news conference of the dangers the salt-and-ice challenge poses to children and adults alike.
"The injury is similar to frostbite that can result in mild cold injury, but it also could increase in severity based on the time the ice is applied," Dr. Aballay said. "The longer it goes, the more serious the injury. This patient went for a few minutes, but there have been cases that went for six or seven minutes that resulted in third-degree cold injuries.
"Hopefully his wound will heal," he said, noting a third-degree cold injury can cause scarring or require skin grafts. "We want to warn the community to prevent other cases and initiate a conversation between parents and children to prevent the risks of this."
Salt melts ice by reducing the temperature at which ice can form. Dr. Aballay said the coldness and moisture on the skin during the process causes alterations in proteins while also freezing fluids in the skin cells. While the three degrees of cold injury don't cause as severe skin damage as first-, second- and third-degree burns, serious skin damage and even destruction can occur.
The mother, who asked that her name not be published, said her twin sons invited a friend to a June 22 sleepover at their house. She was sleeping at 3 a.m. last Saturday when the boys undertook the challenge.
She said her son kept the salt and ice on his back for 20 minutes -- not several minutes as the doctor said -- with the skin eventually going numb as the other boys continued adding ice. At 9:30 a.m., the pain prompted the boy to show his mother the injury. The friend also had a red mark on the back of his hand from attempting the challenge. She yelled at her sons, but anger turned to panic that afternoon when redness turned into a blistering mess.
She rushed her son to the emergency room, where doctors initially said the injury could cause scarring. She also was told that her son had first- and second-degree cold injuries on his back with a third-degree injury the size of a nickel in the center of the cross.
"I want parents to go to Facebook and YouTube and be aware of this and all the other Internet challenges," the mother said. "Kids are so impressionable, and you can tell them 'no' until you're blue in the face."
Ever since her son's injury, she said, she has heard stories from others about their children trying the salt-and-ice challenge, including a lacrosse team that used it to initiate players. On YouTube, mostly boys and young men take the challenge, often writhing in pain as they clench salt and an ice cube in a fist, then proudly show their red injuries and blisters afterward. An unwitting beauty adviser did a video after a viewer recommended the procedure as a way to exfoliate the skin. After a painful experience, including screams and gyrations, she abandons the process and shows the camera a frozen patch of skin on her arm.
Experiencing periodic stinging and burning throughout the week, the local boy began showing marked improvement Friday, his mother said, noting that blisters and peeled skin were giving way to redness.
"Now I say it daily: 'When you are with other kids, stop and think before you do anything,'" she said. "But whenever you get a group of kids together, they are going to do things. It's peer pressure, even if they don't want to do it."
David Templeton: firstname.lastname@example.org or 412-263-1578.