A mysterious rash and pain on a 61-year-old man's back stumped both an urgent care clinician and a dermatologist, who suspected shingles or an allergic reaction. The surprising culprit, discovered by the patient's wife, was not a complex skin condition but a thermal burn from an ice pack used for chronic low back pain. This case, and another involving a runner who left a pack on for two hours, highlights a common yet overlooked danger: improper ice application.

The article stresses that ice packs, a staple of RICE (Rest, Ice, Compression, Elevation) therapy, can cause significant skin damage if used incorrectly. To prevent injury, patients must be warned never to place an ice pack directly on the skin, regardless of packaging claims. Instead, a protective layer like a towel should always be used, and application time limited to 10-20 minutes at most.

If an ice burn does occur, treatment involves removing the ice and gradually warming the area with a warm (not hot) towel or bath. Blisters should not be popped, and you should seek medical attention if the skin remains cold, hard, or numb.