Cold panniculitis

Background
  • Also known as Haxthausen disease
  • Exposure to cold temperatures → inflammation and mild necrosis of subcutaneous fat tissue
  • Infants are most susceptible due to higher percentage of saturated fatty acids in newborn fat tissue[1]
    • Usually caused by popsicles, exposure to cold environments (e.g. on the face and hands which are often uncovered), and ice packs (i.e. used to control fever and pain after vaccination)[2]
    • Also seen frequently in equestrians (esp young women) riding in cold temperatures[2]

Clinical Features
  • Erythematous, indurated, tender, firm plaques or nodules on areas exposed to cold[2]
  • Lesions develop 24-72 hours after exposure and resolve within 2 weeks[3]
  • Resolution may result in adipose fibrosis with cosmetic defects (especially if area is not protected from further cold exposure)

Differential Diagnosis

Cold injuries

Evaluation
  • Clinical diagnosis
  • Reproduction of lesions approximately half a day after application of an ice cube to the volar forearm for 2 minutes may help with diagnosis[2][3]

Management
  • Protect affected area from further cold exposure
  • Otherwise, no specific treatment (lesions resolve spontaneously)

Disposition
  • Discharge

See Also

References
  1. Bolotin D, et al. Cold panniculitis following ice therapy for cardiac arrhythmia. Pediatr Dermatol. 2011 Mar-Apr;28(2):192-4.
  2. Quesada-Cortés A, et al. Cold panniculitis. Dermatol Clin. 2008 Oct;26(4):485-9
  3. Lipke MM, Cutlan JE, Smith AC. Cold panniculitis: delayed onset in an adult. Cutis. 2015 Jan;95(1):21-4.
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