Cold Panniculitis Clinical Presentation

Updated: May 14, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Presentation

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. [9]  Equestrian cold panniculitis was documented in a cold-storage-room worker. [10]

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Physical Examination

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), [11] as shown in the image below. Skin color changes are red or violet. One report describes toe involvement. [12]

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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Complications

Cold panniculitis (CP) is a self-limiting disorder.

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