What are the other Names for this Condition? (Also known as/Synonyms)

• Cold-Induced Panniculitis
• CP (Cold Panniculitis)

What is Cold Panniculitis? (Definition/Background Information)

• Cold Panniculitis (CP) is an acute condition resulting in the inflammation of subcutaneous fat tissue just beneath the skin, on exposure to cold temperatures. The term ‘panniculitis’ indicates an inflammation of fat (adipose) tissue
• Cold Panniculitis can occur in all ages, although infants, children, and obese women are more vulnerable to the condition. Exposure to cold can take place when very young children lick on ice creams, through using icepacks on infants, or from outdoor activities during cold winters
• The condition causes the presence of generally painless subcutaneous nodules at the site of cold exposure, which may be red in color. Usually, the face is involved in infant children, while the thighs and buttocks may be affected in older adults (especially women)
• No severe symptoms or adverse complications have been reported for Cold Panniculitis. In many, the condition does not require any treatment and it gets better on its own (self-limiting condition). The prognosis of Cold Panniculitis is typically excellent

Who gets Cold Panniculitis? (Age and Sex Distribution)

• Cold Panniculitis is a rare condition that is mostly observed in newborns and very young children. It may be also observed in adults
• However, women who are obese are affected much more than men. In infants and children, both males and females are affected almost equally
• No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Cold Panniculitis? (Predisposing Factors)

• The risk factors for Cold Panniculitis include exposure to severe cold or injury from cold. This may occur from:
  • Young children eating or licking on an ice-cream, which can result in popsicle panniculitis
  • Use of cold for therapeutic reasons, such as during a surgical procedure
  • Using an icepack on newborn infants
  • Prolonged outdoor activity during winters such as horse-riding in women (called Equestrian Cold Panniculitis)
• Obese individuals, especially women, have a higher risk for this condition
• Polio-affected individuals have a high risk for Cold Panniculitis on their affected leg or limb
• Individuals with chilblains, which is a skin condition caused by exposure to cold conditions, are also at risk for Cold Panniculitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Cold Panniculitis? (Etiology)

• Cold Panniculitis occurs following prolonged exposure to cold conditions
• It is reported that the subcutaneous fat crystalizes on exposure to non-freezing cold temperatures resulting in inflammation of the exposed region

What are the Signs and Symptoms of Cold Panniculitis?

The signs and symptoms of Cold Panniculitis may be seen within a few hours following exposure to cold, or even after 1-3 days. Rarely, it may be observed even after a week. The signs and symptoms may include:

• The presence of thickened skin causing nodules and plaques; usually, it manifests as localized thickening
• Cold Panniculitis is mainly observed at the site of cold exposure. Any part of the body skin may be involved
• The skin over the nodules may have a slightly reddish or purplish discoloration
• In young children, it is the face that is commonly affected, which includes the cheeks, lips, and forehead
• No pain or itching is generally observed
• During winters, in women who are overweight or obese, many cases are reported involving the legs, thighs, buttocks, and even the lower abdomen region; these may be itchy in some cases

How is Cold Panniculitis Diagnosed?

Cold Panniculitis may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history
• Assessment of the signs and symptoms
• Radiographic studies of the affected region, if needed
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin or tissue biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A differential diagnosis to exclude the following conditions may be necessary prior to a definitive diagnosis:
  • Chilblains
  • Frostbite; tissue damage that occurs when exposed to freezing cold
  • Infectious cellulitis
  • Metastatic neuroblastoma
  • Post-steroid panniculitis
  • Sclerema neonatorum
  • Subcutaneous fat necrosis of the newborn
  • Traumatic panniculitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Cold Panniculitis?

In a majority of individuals, no significant complications due to Cold Panniculitis are noted.

How is Cold Panniculitis Treated?

In many individuals, no treatment is necessary for Cold Panniculitis, since it is known to resolve spontaneously. If required, the following measures may be considered:

• Symptomatic and supportive therapy
• Gradually thawing the affected skin region can help in recovery
• Systemic medications for severe condition
• Topical applications are generally not helpful

How can Cold Panniculitis be Prevented?

• Avoiding exposure to cold weather and cold temperatures can help prevent Cold Panniculitis
• Educating parents and caretakers of newborn children and infants is beneficial

What is the Prognosis of Cold Panniculitis? (Outcomes/Resolutions)

The prognosis of Cold Panniculitis is typically excellent, since it is a self-limiting condition with no severe symptoms or complications being noted.

Additional and Relevant Useful Information for Cold Panniculitis:

There are many different types of panniculitis and it has been difficult to obtain an accurate picture of their true incidence, since they may be associated with so many conditions. Some of the different types include:

• Lupus panniculitis
• Pancreatitis-associated panniculitis
• Alpha-1 antitrypsin deficiency associated panniculitis
• Infective panniculitis