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Cold Panniculitis

Cold Panniculitides

Cold panniculitis is a dermatological condition that involves a sudden-onset nodular rash, developing in regions of the body that have been subject to a cold temperature, due to inflammation of adipose tissue.


Cold panniculitis (CP) is a disorder that can affect both adults and children. It is caused by exposure of various regions of the body to a cold temperature and, subsequently, there is a wide range of areas on which it may appear.

Patients may present with indurated nodules in areas of the body exposed to cold. The nodules have ill-defined margins and appear approximately 1 to 3 days following the exposure. The erythematous lesions are expected to develop to painful and firm nodules over the days [1]. Pediatric patients tend to exhibit them on the forehead and cheeks and rarely on the extremities such as the toes, with the lesions assuming a lilac/red color [2] [3] [4]. This is attributed to these two areas of the body being more constantly exposed to a cold temperature during the winter and less protected [5]. Cold panniculitis does not lead to systemic involvement and, therefore, constitutional symptoms are not reported. Except for the characteristic dermatological manifestations, a medical history of fever is the sole complaint that may accompany a case of CP.

The induration gradually subsides and the disorder is a self-limiting one, eventually resolving in approximately two weeks [6]. Ulceration of the nodules or plaque formation and crusting thereof may also be observed [5].

Several sub-categories of CP have been reported in the literature. Equestrian cold panniculitis is a type of CP that involves nodular lesions appearing in young women who engage in horse-riding [7]. Cold is also the culprit behind these cases and the lesions are typically observed on the upper lateral part of the thigh, with bilateral involvement being a possibility. Popsicle panniculitis is a type of cold panniculitis that occurs following sucking on an ice cube or popsicle, with lesions appearing on the cheeks. Lastly, a case has been reported, concerning CP-induced by a cold therapy unit, in which the rash failed to appear until 10 days after treatment was started [8].

Constitutional Symptom
  • Cold panniculitis does not lead to systemic involvement and, therefore, constitutional symptoms are not reported.[symptoma.com]
Down Syndrome
  • Syndrome Hull The Jean Bishop Integrated Care Centre, Hull The Jean Bishop Integrated Care Centre – Ray’s Story Primary care Medicines waste eConsult GP online Better care in Hull Social prescribing Humber Transforming Care Partnership Previous Projects[hullccg.nhs.uk]
  • This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts.[statpearls.com]
Increased Energy
  • Participants in the study demonstrated increased energy expenditure when their bodies were cooled with thermo-blankets.[collectivewizdom.com]
Back Pain
  • We describe 2 adult patients using ice-pack therapy for chronic back pain who developed erythematous, purpuric plaques at the site of ice-pack application.[ncbi.nlm.nih.gov]


A targeted medical history and careful physical examination are the key steps towards achieving an accurate diagnosis, given that CP is primarily seen clinically.

There are usually no laboratory tests that can aid in the diagnosis of this medical entity, as cryofibrinogens and cryoglobulins tend to be negative [7]; a histopathological analysis of a biopsy sample harvested from a lesion is the sole means of confirmation of CP. A biopsy is usually ordered in diagnostically challenging cases of cold panniculitis. The following results are compatible with the disorder:

  • Infiltration of fat lobules by lymphocytes and histiocytes. The perivascular infiltration in the dermis by lymphocytes is observed predominantly at the dermal-epidermal junction.
  • The absence of vasculitis.
  • Abnormal findings are only exhibited in the adipose tissue.


  • To our knowledge, this is the first report of cold panniculitis caused by treatment of a cardiac arrhythmia with ice packs.[ncbi.nlm.nih.gov]
  • Ice therapy has long been used as first line treatment of supraventricular tachycardia in neonates. We report a case of cold panniculitis developing in a 12-day-old neonate after ice therapy for cardiac arrhythmia.[ncbi.nlm.nih.gov]
  • Many chapters have been completely revised to reflect the latest treatment recommendations, procedures and therapeutic guidelines.[books.google.com]
  • Panniculitis Treatment The treatment of Panniculitis is usually carried out in different ways. If the doctor diagnoses you with Panniculitis, he would usually prescribe you anti-inflammatory medicines of a non-steroidal nature.[primehealthchannel.com]
  • Stay at the forefront of your field with updated treatment methods throughout, as well as an increased focus on patients with skin of color.[books.google.de]


  • Prognosis The prognosis is excellent because most cases resolve without adverse affects. Patient Education Educate patients about avoiding exposure to cold.[emedicine.medscape.com]
  • The prognosis is also poorer in sclerema neonatorum in contrast to SCFN. Cold panniculitis is limited to areas exposed to cold and was ruled out due to absence of history of exposure to cold.[e-ijd.org]


  • In most cases, the etiologic factor is chemical, by the subcutaneous self-injection of disparate substances, usually denied by patients, being a manifestation of an underlying psychiatric disturbance, or of drug or alcohol abuse.[link.springer.com]
  • These changes also may occur in those infants classified as being sickly in whom minimal exposure to the cold has occurred. [6] Etiology Cold panniculitis is caused by cold injury in children and in women who are obese.[emedicine.medscape.com]
  • Etiology Different predisposing factors play an important role in the etiology of subcutaneous fat necrosis of the newborn.[drmhijazy.com]
  • Idiopathic nodular panniculitis, also known as Weber-Christian disease, is of unknown etiology. Lesions most typical on the lower extremities, but can occur on the trunk. There can be an associated fever, malaise, arthralgia, and myalgia.[skincareguide.ca]
  • The disease is transient in nature and often complicated by hypercalcemia. [1] Though the exact etiology is unknown, it has been postulated that SCFN of the newborn is caused by neonatal stress and hypothermia due to various causes.[e-ijd.org]


  • It may also be caused by whole-body cryotherapy [7] or ice therapy for supraventricular tachycardia. [8] Epidemiology Frequency United States Frequency peaks during infancy and childhood and in adult women who are obese.[emedicine.medscape.com]
Sex distribution
Age distribution


  • 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[emedicine.medscape.com]


  • Vasodilator drugs are not effective in preventing or treating cold panniculitis.[dermaamin.com]
  • Topical therapies are unlikely to penetrate sufficiently to be effective, and systemic agents are required. [22] Author Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine[emedicine.medscape.com]
  • 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[emedicine.medscape.com]
  • Early treatment will help you prevent any serious health situation in future and enjoy life in the best of your health. References :[primehealthchannel.com]



  1. 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 Oct;38(10):726-31.
  2. 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.
  3. Holla RG, Prasad AN. Cold panniculitis neonatorum. Indian Pediatr. 2009 Jan;46(1):75.
  4. Patterson JW. Panniculitis. In: Bolognia J, Jorizzo J, Rapini R, eds. Dermatology. 2nd ed. St. Louis, MO: Mosby Elsevier;2008:1515-1530.
  5. Quesada-Cortés A, Campos-Muñoz L, Díaz-Díaz RM, et al. Cold panniculitis. Dermatol Clin. 2008;26:485-489.
  6. Page EH, Shear NH. Temperature-dependent skin disorders. J Am Acad Dermatol. 1988;18(5, pt 1):1003-1019.
  7. Beacham BE, Cooper PH, Buchanan CS, Weary PE. Equestrian cold panniculitis in women. Arch Dermatol. 1980 Sep;116(9):1025-7.
  8. Lipke MM, Cutlan JE, Smith AC. Cold Panniculitis: Delayed Onset in an Adult. Cutis. 2015 January;95(1):21-24

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Last updated: 2019-07-11 21:31