eMedicine Specialties > Dermatology > Diseases of the Subcutaneous Tissue
Cold Panniculitis
Updated: May 6, 2009
Introduction
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
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.
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.3 Some overlap occurs, and cold panniculitis of the newborn has been associated with ice pack application.4
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.5
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.5
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.
Mortality/Morbidity
Most cases of cold panniculitis resolve without any adverse effects.
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.
Clinical
History
- The eruptive phase usually begins 48 (6-72) hours 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.
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).6 One report describes toe involvement.7
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.
- Skin color changes are red or violet.
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.
More on Cold Panniculitis |
 Overview: Cold Panniculitis |
| Differential Diagnoses & Workup: Cold Panniculitis |
| Treatment & Medication: Cold Panniculitis |
| Follow-up: Cold Panniculitis |
| Multimedia: Cold Panniculitis |
| References |
| Next Page » |
References
Beacham BE, Cooper PH, Buchanan CS. Equestrian cold panniculitis in women. Arch Dermatol. Sep 1980;116(9):1025-7. [Medline].
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].
Balazs M. Subcutaneous fat necrosis of the newborn with emphasis on ultrastructural studies. Int J Dermatol. May 1987;26(4):227-30. [Medline].
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].
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].
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].
Holla RG, Prasad AN. Cold panniculitis neonatorum. Indian Pediatr. Jan 2009;46(1):75. [Medline].
Quesada-Cortes A, Campos-Munoz L, Diaz-Diaz RM, Casado-Jimenez M. Cold panniculitis. Dermatol Clin. Oct 2008;26(4):485-9, vii. [Medline].
Braun-Falco O, Plewig G, Wolff HH. Erkrankung des Fettqewebes. In: Dermatologie und venerolgoie. Berlin, Germany: Springer; 1997:488,781-2.
Haxthausen H. Adiponecrosis a fripore. Br J Dermatol. 1941;33:83-89.
Kellum RE, Ray TL, Brown GR. Sclerema neonatorum. Report of a case and analysis of subcutaneous and epidermal-dermal lipids by chromatographic methods. Arch Dermatol. Apr 1968;97(4):372-80. [Medline].
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.
Silverman AK, Michels EH, Rasmussen JE. Subcutaneous fat necrosis in an infant, occurring after hypothermic cardiac surgery. Case report and analysis of etiologic factors. J Am Acad Dermatol. Aug 1986;15(2 Pt 2):331-6. [Medline].
Solomon LM, Beerman H. Cold panniculitis. Arch Dermatol. Dec 1963;88:897-900. [Medline].
Thomsen RJ. Subcutaneous fat necrosis of the newborn and idiopathic hypercalcemia. Report of a case. Arch Dermatol. Oct 1980;116(10):1155-8. [Medline].
Further Reading
Keywords
cold panniculitis, cold injury, cold exposure, cold-induced panniculitis, CP, chilblains, perniosis, CP of the newborn, infant CP
