Chilling the skin of this five-year-old boy was like sticking a dagger into him. Contact with any cold object brought him unbearable pain. Even a moderately cool drink would make him vomit. It had been that way ever since birth, his parents told us. Our patient treated a cold object as the rest of us would treat an open flame. There was no family history of such a condition.

On examination this little boy was a happy healthy individual with perfectly normal skin. But when he was held down, his trust betrayed, to test his skin reaction to a tiny ice chip, he became a pathetic screaming child covered with tears and muscle spasms. The test site with the ice chip flared out four inches with bright red skin and local sweating. The edges of the erythema were irregular, as seen with blood vessel dilatation induced by local nerve paths. There was no hive. The redness and screaming remained for a full hour. Later, the skin was perfectly normal again.

Testing with tubes of water at varying temperatures showed that his reaction developed whenever the temperature was below 68°F. Hot water was tolerated normally, but being put in a cool room was tragic torture. His skin sensory system seemed normal with touch and pain responses being unremarkable.

We had never seen such a reaction to cold. As we reviewed our experience with cold as a cause of disease we remembered that we had seen hives develop in chilled skin.