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. [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]
Etiology
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. 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. 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.
Prognosis
The prognosis is excellent because most cases resolve without adverse affects.
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Classic presentation of cold panniculitis with nodular red swellings over the cheeks.
