You are in: eMedicine Specialties > Dermatology > DISEASES OF THE SUBCUTANEOUS TISSUE Cold PanniculitisArticle Last Updated: Jan 23, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Geromanta Baleviciene, MD, Head and Professor, Department of Dermatology, Vilnius University, Medical Faculty, Lithuania Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Richard J Cervin, MD, Consulting Staff, Department of Dermatology, Baltic-American Medical and Surgical Clinic, Lithuania Editors: Ponciano D Cruz Jr, MD, Vice-Chair, JB Shelmire Professor, Department of Dermatology, University of Texas Southwestern Medical Center; David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic; Christen M Mowad, MD, Assistant Professor, Department of Dermatology, Geisinger Medical Center; Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: cold injury, cold exposure, cold-induced panniculitis, CP, chilblains, perniosis, CP of the newborn, infant CP INTRODUCTIONSection 2 of 10
  BackgroundCold panniculitis (CP) is an acute, nodular, erythematous eruption usually limited to areas exposed to the cold. CP results from a cold injury to adipose tissue. Many patients classified as having CP or equestrian cold panniculitis have forms of perniosis that represent dermal vascular injury rather than true panniculitis. PathophysiologyIn CP, 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. CP needs to be distinguished from other disorders such as adiponecrosis subcutanea (subcutaneous fat necrosis of the newborn, CP of the newborn) and sclerema neonatorum. Some overlap occurs, and CP of the newborn has been associated with ice pack application. In CP 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. 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. FrequencyUnited StatesFrequency peaks during infancy and childhood and in adult women who are obese. Other cold injuries are relatively frequent. InternationalCP is a rare disorder in which the diagnosis probably is hampered by overlapping terminology. Mortality/MorbidityMost cases of CP resolve without any adverse effects. RaceNo racial predilection is known. SexAdult women who are obese most commonly have CP. During childhood and infancy, an equal incidence exists for the sexes. AgeCP occurs during infancy and childhood and in adult women who are obese. CLINICALSection 3 of 10
History
PhysicalPertinent physical findings are limited to the skin.
Causes
DIFFERENTIALSSection 4 of 10
Lupus Erythematosus, Acute Lupus Erythematosus, Drug-Induced Scleredema Sclerema Neonatorum
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| Media file 1: Classic presentation of cold panniculitis with nodular red swellings over the cheeks. | |
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Article Last Updated: Jan 23, 2007
