By Gary M. White, MD
Cold panniculitis is a form of traumatic panniculitis in which damage to the fat layer occurs after prolonged cold exposure.
Subcutaneous tender nodules often at times with a cyanotic discoloration within hours to several days of cold exposure is characteristic of cold panniculitis. It most classically occurs on the outer thighs of women after horseback riding in the cold [JEADV 2017;31;1029]. However, other prolonged activities in the cold, e.g., sledding or motorcycle riding, have also been reported. It may occur on the cheeks of a child after prolonged exposure to either cold or a popsicle, so called "popsicle panniculitis."
Typical deep-set inflammatory nodules with the appropriate history may be sufficient for diagnosis. Otherwise an excisional biopsy deep enough to adequately sample the fat layer is necessary.
Spontaneous resolution will occur in several weeks as long as the cold source is removed.
This woman would work outside in the cold, triggering the lesions. But this pattern is also seen in horseback riders (equestrian panniculitis). Dermatology Online Journal 21(1)
Red plaque on the cheek of an infant. Created through inspiration
A 25 year old woman presented with tender erythematous subcutaneous plaques and nodules restricted to her thighs. She had crops of new lesions throughout the winter. Her job was a horseback rider BMJ. 2006 Sep 9; 333(7567): 558.
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