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Cold Panniculitis

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


Cold panniculitis (CP) is an acute, nodular, erythematous eruption usually limited to areas exposed to the cold. Cold panniculitis results from a cold injury to adipose tissue. Many patients classified as having cold panniculitis or equestrian cold panniculitis have forms of perniosis that represent dermal vascular injury rather than true panniculitis.[1, 2]



In cold panniculitis, localized cold damage leads to inflammation of the subcutaneous adipose tissue and is particularly likely to occur in patients with chilblains or in paralyzed limbs affected by poliomyelitis. The association with chilblains (perniosis) complicates the terminology and classification of patients with cold injury.[3]

Localized chilling of the tissues of the thigh, buttocks, and lower abdomen is more likely to occur in women who are obese during the winter months because of increased cold exposure. In infants, the cheeks and forehead are areas that may be affected.

Cold panniculitis needs to be distinguished from other disorders such as adiponecrosis subcutanea (subcutaneous fat necrosis of the newborn, cold panniculitis of the newborn) and sclerema neonatorum.[4] Some overlap occurs, and cold panniculitis of the newborn has been associated with ice pack application.[5]

In cold panniculitis of the newborn (adiponecrosis subcutanea), cold injury in the full-term newborn may occur with focal fat necrosis and a granulomatous and fibrous panniculitis in which the infiltrate usually contains multifocal histiocyte foreign body giant cells containing bifringent star-shaped crystals.[6]

In sclerema neonatorum, a usually fatal disorder of infants who are premature or debilitated, histologic findings reveal needle-shaped crystals forming apparent star-shapes in adipose cells. Granulomas are absent. These changes also may occur in those infants classified as being sickly in whom minimal exposure to the cold has occurred.[6]




United States

Frequency peaks during infancy and childhood and in adult women who are obese. Other cold injuries are relatively frequent.


Cold panniculitis is a rare disorder in which the diagnosis probably is hampered by overlapping terminology.


No racial predilection is known.


Adult women who are obese most commonly have cold panniculitis. During childhood and infancy, an equal incidence exists for the sexes.


Cold panniculitis occurs during infancy and childhood and in adult women who are obese.



The prognosis is excellent because most cases resolve without adverse affects.


Patient Education

Educate patients about avoiding exposure to cold.

Contributor Information and Disclosures

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.


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.

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