Cryolipolysis is a noninvasive method to reduce localized fat. It involves the application of controlled cooling to damage adipocytes, which have a higher sensitivity to cold injury compared with surrounding water-rich cells.Cold temperatures trigger adipocyte apoptosis, which, in turn, evokes an inflammatory response. Cryolipolysis is a favored method, as it has minimal side effects, such as transient erythema and bruising.Here, we report a case of morphea triggered by cryolipolysis.

Case report

An otherwise healthy 67-year-old woman underwent a single cryolipolysis session at a nondermatology clinic. This involved the placement of CoolSculpt applicators at 39°F for 60 minutes to her lower abdomen and thighs (CoolSculpt, Allergan via Zeltiq Asthetics, Pleaston, CA).

Six weeks after her procedure, she had multiple firm, thickened sclerotic plaques on her abdomen and thighs—in the same distribution as the CoolSculpt probes ( Fig 1 ). She denied the following before the onset of her cutaneous symptoms: fever, chills, night sweats rhinorrhea, odynophagia, cough, nausea, emesis, arthritis, oral ulcers, other rashes, photosensitivity, temperature sensitivities, or weight changes. Her family history is negative for thyroiditis and autoimmune conditions such as lupus.

Skin biopsies from the left thigh and the right abdomen found the following: orthokeratosis overlying an atrophic dermis; full-thickness dermal collagen sclerosis; perivascular and interstitial infiltrate, predominantly lymphocytic with scattered plasma cells; and negative periodic acid–Schiff and colloidal stains ( Figs 2 and 3 ). The histopathology findings were consistent with the clinical impression of morphea.

The patient trialed the following topical therapies using a Youth Stream 6-in-1 titanium derma-roller (depth 1.5 mm) (Youth Stream Group, Chicago, IL): calcipotriol (Dovonex, LEO Pharma INC, Thornhill, Canada) twice daily during the week and halobetasol propionate 0.05% ointment (Ultravate, Valeant Canada LP, Laval, Quebec) twice daily on weekends. She simultaneously underwent ultraviolet light therapy 3 times weekly, which was discontinued after 1 month because of phototoxicity.

The patient's lesions subsequently spread to her bilateral labia majora, causing severe ongoing pain and allodynia. She was treated with a tapered course of prednisone (40 mg/d; dose decreased by half every 2 weeks), 20 mg once weekly of methotrexate, and 1 mg daily of folic acid. Her topical regimen was amended as follows: tacrolimus 0.1% ointment (Protopic, LEO Pharma INC) twice daily during the week and halobetasol propionate 0.05% ointment (Ultravate) twice daily on the weekends.

Over 3 months, she had significant clinical improvement; her lesions resolved with hyperpigmentation, and she had a subsequent decrease in pain.