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Cold Panniculitis

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

Background

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]

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Pathophysiology

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]

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Epidemiology

Frequency

United States

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

International

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

Race

No racial predilection is known.

Sex

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

Age

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

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Prognosis

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

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Patient Education

Educate patients about avoiding exposure to cold.

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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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