Cold Panniculitis Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 25, 2011
 

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.[6]

Next

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.

Cutaneous distribution in children characteristically is on the face (cheeks and forehead),[7] as shown in the image below. Skin color changes are red or violet. One report describes toe involvement.[8]

Classic presentation of cold panniculitis with nodClassic 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.

Previous
Next

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.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Ponciano D Cruz Jr, MD  Vice-Chair, JB Shelmire Professor, 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: RCTS Consulting fee Independent contractor; Mary Kay Cosmetics Honoraria Consulting; Galderma Grant/research funds Principal Investigator

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

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

Disclosure: Nothing to disclose.

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

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

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

Disclosure: Nothing to disclose.

References

  1. Beacham BE, Cooper PH, Buchanan CS. Equestrian cold panniculitis in women. Arch Dermatol. Sep 1980;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. Jun 2000;25(4):285-8. [Medline].

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

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

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

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

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

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

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

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

  11. 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. Mar 2010;49(3):295-7. [Medline].

  12. Braun-Falco O, Plewig G, Wolff HH. Erkrankung des Fettqewebes. In: Dermatologie und venerolgoie. Berlin, Germany: Springer; 1997:488,781-2.

  13. Haxthausen H. Adiponecrosis a fripore. Br J Dermatol. 1941;33:83-89.

  14. Rook A, Wilkinson DS, Ebling FJG, eds. Subcutaneous Fat Necrosis of the Newborn. In: Textbook of Dermatology. 3rd ed. Oxford, England: Oxford University Press; 1979:204-7.

 
Previous
Next
 
Classic presentation of cold panniculitis with nodular red swellings over the cheeks.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.