Deodorant Spray: A Newly Identified Cause of Cold Burn ... - Pediatrics

Deodorant Spray: A Newly Identified Cause of Cold Burn
Ulrich May, Karl-Heinz Stirner, Roger Lauener, Johannes Ring and Matthias
Möhrenschlager
Pediatrics 2010;126;e716;
originally published online August 2, 2010;
DOI: 10.1542/peds.2009-2936
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/126/3/e716.full.html
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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Deodorant Spray: A Newly Identified Cause of
Cold Burn
abstract
Two patients encountered a first-degree cold burn after use of a deodorant
spray. The spray-nozzle to skin-surface distance was 5 cm,
and the spraying lasted 15 seconds. Under laboratory conditions, the
deodorant in use was able to induce a decline in temperature of 60°C.
These 2 cases highlight a little-known potential for skin damage by
deodorant sprays if used improperly. Pediatrics 2010;126:e716–e718
e716 MAY et al
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AUTHORS: Ulrich May, MD, a Karl-Heinz Stirner, MD, b
Roger Lauener, MD, b Johannes Ring, MD, PhD, c and
Matthias Möhrenschlager, MDa Departments of aDermatology and Allergology and bPediatrics, Allergieklinik, Hochgebirgsklinik/Christine Kühne-Center for
Allergy Research and Education, Davos, Switzerland; and
cDepartment of Dermatology and Allergy Biederstein, Technical
University of Munich, Munich, Germany
KEY WORDS
frostbite, deodorant, propellant
www.pediatrics.org/cgi/doi/10.1542/peds.2009-2936
doi:10.1542/peds.2009-2936
Accepted for publication May 6, 2010
Address correspondence to Matthias Möhrenschlager, MD,
Department of Dermatology and Allergology, Allergieklinik,
Hochgebirgsklinik/Christine Kühne-Center for Allergy Research
and Education, Herman-Burchard-Strasse 1, CH-7265 Davos,
Switzerland. E-mail: matthias.moehrenschlager@hgk.ch
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2010 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.

Although deodorant sprays are applied
many million times per day, cold
burns after use of these devices have
been rarely mentioned in the medical
literature. 1–4 Here, we report a cluster
of frostbite injuries caused by the improper
use of an aerosol spray.
CASE REPORTS
A 14-year-old mixed-race (black/white)
girl (patient 1) complained of localized
pain and dark discoloration on her
right hand 1 day after use of a deodorant
spray (Rexona Girl Dance Energy
[Unilever, Thayngen, Switzerland]) (Fig
1) within a distance of 5cmfor15
FIGURE 1
Aerosol deodorant that was used within a few
centimeters of the cutaneous surface.
FIGURE 2
First-degree frostbite on the dorsum of the hand after low-distance spraying of a deodorant for 15
seconds (patient 1).
FIGURE 3
Temperature recorded by a contact thermometer (Fluke 51 II) according to time of exposure to the
aerosol spray in use. The distance from the spray nozzle to the measuring point of the thermometer
was 5 cm.
seconds. The reason for this kind of exposure
was, according to the patient, “a
test of courage.” Except for atopic eczema
and allergic asthma, her general
medical history was uneventful. A
healthy 45-year-old white friend of patient
1 (patient 2), who did not believe the
report given by patient 1, reapplied the
deodorant spray at a similar distance
and for a similar amount of time.
Macroscopically, patients 1 and 2
showed on the right dorsum of their
hands a 4- 3-cm and a 3- 2-cm,
respectively, erythematous macula
with sharply confined margins representing
first-degree frostbite (Fig 2).
CASE REPORT
The lesions were treated with nonadhesive
dressings and topical corticosteroids
at night and ultraviolet-ray
protection during the day.
As a sequela, a postinflammatory hypopigmentation
(patient 1) and a hyperpigmentation
(patient 2) became
evident after several weeks of treatment.
The patients were encouraged to
continue with ultraviolet-ray protection
for the next months.
Figure 3 (created with Excel 2003
[Microsoft Corp, Redmond, WA]) depicts
the obtained temperature/
exposure-time curve of the deodor-
PEDIATRICS Volume 126, Number 3, September 2010 e717
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ant aerosol sprayed on a contact
thermometer (Fluke 51 II [Fluke Corp,
Everett, WA]) within a distance of 5
cm and recorded for 15 seconds
starting at a room temperature of
22.1°C. A decline in temperature of
60°C was demonstrated.
DISCUSSION
Frostbite is a disorder caused by the
actual freezing of tissue beginning at
temperatures of 2°C to 10°C. 1 Similar
to burns caused by heat, the duration
of exposure, affected region, immobility,
and other factors may
influence the amount of skin damage
encountered. 5,6
Low temperature-related effects can
be induced, for example, by direct injury
to the cell with intracellular ice
formation, hypoxia caused by vessel
constriction, and damage from inflammatory
mediators. 7
According to Amonton’s law, 8 the pressure
(P) of a gas is proportional to the
absolute temperature (T) for a fixed
quantity of gas in a fixed volume:
P1/T1 P2/T2. Therefore, a decline in
the pressure of a gas (eg, by spraying
the content of an aerosol can) results
in a decline of temperature.
Cooling effects may also arise from the
low boiling points of propellants (eg,
42.2°C for propane, 11.7°C for
isobutane, and 0.6°C for butane).
REFERENCES
1. Petrone P, Kuncir EJ, Asensio JA. Surgical
management and strategies in the treatment
of hypothermia and cold injury. Emerg Med
Clin North Am. 2003;21(4):1165–1178
2. Lacour M, Le Coultre C. Spray-induced frostbite
in a child: a new hazard with novel aerosol
propellants. Pediatr Dermatol. 1991;8(3):
207–209
3. Elliott DC. Frostbite of the mouth: a case report.
Mil Med. 1991;156(1):18–19
e718 MAY et al
Another possible cause for cutaneous
affection may arise from hypertonic
damage by the aerosol. 7
In contrast to protein denaturation
caused by heat burns, preserved dermal
collagen prevents significant scarring
after cold burns unless the freezing
contact is particularly prolonged. 9
In the literature, several reports deal
with frostbite injuries after improper
use of an aerosol spray by young persons.
Lacour and Le Coultre2 discussed
an 8-year-old boy who sustained a cold
burn after spraying his forearm with a
toilet air-freshener aerosol at close
range for an unknown period of time.
The aerosol in question used butane
and propane as propellants. As in our
case, the authors demonstrated that
such a spray could induce a substantial
decrease in temperature (40°C)
when sprayed onto a toluene thermometer
at close range.
Elliott3 described a young boy who experienced
a second-degree frostbite
injury to his oral cavity, including the
lower lip, hard palate, tongue, and buccal
mucosa. This unusual injury occurred
as a result of substance abuse
via inhalation of an aerosolized propane
propellant as a means of achieving
euphoria.
As an act “out of curiosity,” Camp et al4 reported the cases of 2 teenaged girls
who sprayed their forearms and ankle
4. Camp DF, Ateaque A, Dickson WA. Cryogenic
burns from aerosol sprays: a report
of two cases and review of the
literature. Br J Plast Surg. 2003;56(8):
815–817
5. Möhrenschlager M, Ring J, Henkel V. Iatrogenic
neonatal burns: more causes. Pediatr
Dermatol. 2008;25(2):285–286
6. Möhrenschlager M, Weigl LB, Haug S, et al.
Iatrogenic burns by warming bottles in the
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with a deodorant by holding the nozzle
1 cm from the skin surface for a period
of 20 to 30 seconds, which resulted
in first- and second-degree
frostbite injuries, respectively. The
spray used by the girls contained butane
and propane as propellants. In an
experiment for which the same type of
deodorant was used, Camp et al
sprayed the contents onto the bulb of
an alcohol thermometer from a distance
of 1 cm and recorded the temperature
reached. After spraying for 5
seconds, the starting temperature
(21°C) decreased to 0°C and declined
further to 8°C, 13°C, and 15°C after
10, 15, and 20 seconds of spraying,
respectively. 3
The spray in our case contained propane,
isobutane, and butane as propellants.
The producer informed us on a
written warning on the spraying device
that the product must be used from a
minimum distance of 15 cm and that
prolonged spraying should be avoided
(Karin Zimmermann, Unilever, written
communication Ref 13069903, 2009).
CONCLUSIONS
These cases highlight a little-known
potential for skin damage from deodorant
sprays when used improperly.
However, in a majority of cases, the
patients were obviously aware that
such improper use would cause skin
damage.
neonatal period. J Burn Care Rehabil. 2003;
24(1):52–55; discussion 49
7. Dawber R. Cold kills! Clin Exp Dermatol. 1988;
13(3):137–150
8. Lide DR. CRC Handbook of Chemistry and
Physics. 90th ed. Boca Raton, FL: Taylor &
Francis; 2009
9. Shepherd JP, Dawber RP. Wound healing and
scarring after cryosurgery. Cryobiology.
1984;21(2):157–169

Deodorant Spray: A Newly Identified Cause of Cold Burn
Ulrich May, Karl-Heinz Stirner, Roger Lauener, Johannes Ring and Matthias
Möhrenschlager
Pediatrics 2010;126;e716;
originally published online August 2, 2010;
DOI: 10.1542/peds.2009-2936
Updated Information &
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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