Several days after exposure to cold a panniculitis may develop in the subcutaneous tissue below the exposed skin.


Clinical features:

(1) erythematous, indurated plaques or nodules

(2) develop 1-3 days after exposure to cold or a prolonged application of ice

(3) tends to occur on the face (especially the cheeks) or lower extremities

(4) usually resolves spontaneously


Histologic features:

(1) The inflammatory cell infiltrate consists of histiocytes, lymphocytes and neutrophils (mixed).

(2) The inflammation tends to be more superficial, with maximum intensity at the interface between the reticular dermis and the subcutaneous fat. It involves both septa and lobules.

(3) Fat necrosis may appear after several days.

(4) Needle-shaped clefts in subcutaneous fat are absent

Variant Forms


popsickle panniculitis

child eating ice or popsickle

equestrian panniculitis

horseback rider in cold weather, often with tight fitting clothes


Differential diagnosis:

(1) frostbite

(2) cold agglutinin disease

(3) Raynaud's phenomenon

(4) sclerema neonatorum (needle-shaped clefts in subcutaneous fat present)

(5) subcutaneous fat necrosis of the newborn (needle-shaped clefts in subcutaneous fat present)

(6) traumatic panniculitis


To read more or access our algorithms and calculators, please log in or register.