Cold Panniculitis Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 21, 2016
 

History

The eruptive phase usually begins 48 hours (range, 6-72 h) after a cold injury to exposed or poorly protected areas. The patient may have a history of a febrile illness or other illness without dermatologic findings. It may occur after ice therapy, a first-line treatment for supraventricular tachycardia in neonates.[7]

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Physical

Pertinent physical findings are limited to the skin. Lesions present as localized indurated nodules with ill-defined margins similar to erythema nodosum. Nodules are raised slightly above the skin line. Nodules are firm or hard and cold and painful.[3]

Cutaneous distribution in children characteristically is on the face (cheeks and forehead),[8] as shown in the image below. Skin color changes are red or violet. One report describes toe involvement.[9]

Classic presentation of cold panniculitis with nod Classic presentation of cold panniculitis with nodular red swellings over the cheeks.

In women who are obese, cutaneous distribution characteristically is on the buttocks, thighs, arms, and under the chin (areas poorly protected from the cold). Thigh lesions, in particular, overlap with perniosis.

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Causes

Cold panniculitis is caused by cold injury in children and in women who are obese. The abnormality probably lies in the chemical composition of the fat tissue. Anoxia, cold, and humidity may play a role.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Christen M Mowad, MD Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Geromanta Baleviciene, MD, and Richard J. Cervin, MD, to the development and writing of this article.

References
  1. Beacham BE, Cooper PH, Buchanan CS. Equestrian cold panniculitis in women. Arch Dermatol. 1980 Sep. 116(9):1025-7. [Medline].

  2. De Silva BD, McLaren K, Doherty VR. Equestrian perniosis associated with cold agglutinins: a novel finding. Clin Exp Dermatol. 2000 Jun. 25(4):285-8. [Medline].

  3. Ferrara G, Cerroni L. Cold-Associated Perniosis of the Thighs ("Equestrian-Type" Chilblain): A Reappraisal Based on a Clinicopathologic and Immunohistochemical Study of 6 Cases. Am J Dermatopathol. 2016 Feb 15. [Medline].

  4. Balazs M. Subcutaneous fat necrosis of the newborn with emphasis on ultrastructural studies. Int J Dermatol. 1987 May. 26(4):227-30. [Medline].

  5. Diamantis S, Bastek T, Groben P, Morrell D. Subcutaneous fat necrosis in a newborn following icebag application for treatment of supraventricular tachycardia. J Perinatol. 2006 Aug. 26(8):518-20. [Medline].

  6. Misgeld V. [Adiponecrosis subcutanea neonatorum--sclerema neonatorum--Buschke's scleredema. Nosography with reference to the literature since 1950]. Arch Kinderheilkd. 1971 May. 183(1):5-22. [Medline].

  7. Bolotin D, Duffy KL, Petronic-Rosic V, Rhee CJ, Myers PJ, Stein SL. Cold Panniculitis Following Ice Therapy for Cardiac Arrhythmia. Pediatr Dermatol. 2010 Aug 4. [Medline].

  8. Huang FW, Berk DR, Bayliss SJ. Popsicle panniculitis in a 5-month-old child on systemic prednisolone therapy. Pediatr Dermatol. 2008 Jul-Aug. 25(4):502-3. [Medline].

  9. Holla RG, Prasad AN. Cold panniculitis neonatorum. Indian Pediatr. 2009 Jan. 46(1):75. [Medline].

  10. Quesada-Cortes A, Campos-Munoz L, Diaz-Diaz RM, Casado-Jimenez M. Cold panniculitis. Dermatol Clin. 2008 Oct. 26(4):485-9, vii. [Medline].

  11. Fernandez RR, Rubio JL, Cano DS, Vicent JR, Solano JL, Centeno NO. Long-term evolution of cytophagic histiocytic panniculitis. J Cutan Med Surg. 2010 May-Jun. 14(3):136-40. [Medline].

  12. Eryilmaz A, Durdu M, Baba M, Bal N, Yigit F. A case with two unusual findings: cutaneous leishmaniasis presenting as panniculitis and pericarditis after antimony therapy. Int J Dermatol. 2010 Mar. 49(3):295-7. [Medline].

  13. Stewart CL, Adler DJ, Jacobson A, et al. Equestrian Perniosis: A Report of 2 Cases and a Review of the Literature. Am J Dermatopathol. 2012 Apr 24. [Medline].

  14. Yang AY, Schwartz L, Divers AK, Sternberg L, Lee JB. Equestrian chilblain: another outdoor recreational hazard. J Cutan Pathol. 2013 May. 40(5):485-90. [Medline].

  15. Günther C, Berndt N, Wolf C, Lee-Kirsch MA. Familial chilblain lupus due to a novel mutation in the exonuclease III domain of 3' repair exonuclease 1 (TREX1). JAMA Dermatol. 2015 Apr. 151 (4):426-31. [Medline].

  16. Grieves JL, Fye JM, Harvey S, Grayson JM, Hollis T, Perrino FW. Exonuclease TREX1 degrades double-stranded DNA to prevent spontaneous lupus-like inflammatory disease. Proc Natl Acad Sci U S A. 2015 Apr 21. 112 (16):5117-22. [Medline].

  17. Grassi S, Borroni RG, Brazzelli V. Panniculitis in children. G Ital Dermatol Venereol. 2013 Aug. 148(4):371-85. [Medline].

  18. Notaro E, Shustov A, Chen X, Shinohara MM. Kikuchi-Fujimoto Disease Associated With Subcutaneous Panniculitis-Like T-Cell Lymphoma. Am J Dermatopathol. 2016 Jun. 38 (6):e77-80. [Medline].

  19. Braunstein I, Werth VP. Update on management of connective tissue panniculitides. Dermatol Ther. 2012 Mar. 25(2):173-82. [Medline].

 
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Classic presentation of cold panniculitis with nodular red swellings over the cheeks.
 
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