Ultra-freeze induced cold contact wheals during cryosurgery: an uncommon subset of acquired cold contact urticaria.

UNLABELLED: Cryosurgery is a safe and effective therapeutic tool for a wide variety of cutaneous and mucocutaneous disorders. Side-effects include transient erythema and oedema.

OBJECTIVE

A series of three patients presenting localized contact wheals minutes after contact with liquid nitrogen in the absence of clinical manifestations of cold urticaria is presented.

METHODS

Specific cold diagnostic provocation tests with liquid nitrogen challenge test, ice cube test and Tempt-test® were performed.

RESULTS

The three patients showed an immediate wheal after cold contact with liquid nitrogen. The ice cube test, the temperature thresholds and the critical stimulation thresholds at 4◦C assessed with the Tempt-test 3.1® were negative. The induced wheals showed pathological features of urticaria. Eight patients suffering from acquired cold urticarial developed also liquid nitrogen induced wheals but none of the healthy controls.

CONCLUSION

A peculiar subset of cold urticaria secondary to exposure to ultra-freeze temperatures developing in patients treated with cryotherapy is reported. The concept of “ultra-freeze urticaria” is proposed.