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Clinical Summary

Cold panniculitis represents acute cold injury resulting in inflammation of the subcutaneous fat. It manifests as erythematous, indurated nodules, and plaques on exposed skin, especially the perioral areas and cheeks. Lesions appear 24 to 72 hours after exposure to cold and gradually soften and return to normal over 1 to 2 weeks usually without permanent sequelae. This phenomenon is caused by subcutaneous fat solidification and necrosis following exposure to cold temperatures. It is much more common in infants. The differential diagnosis includes facial cellulitis, frostbite, trauma, pressure erythema, giant urticaria, and contact dermatitis.

Management and Disposition

Treatment is supportive. Parental education and reassurance are important.


  1. Because these lesions may also be painful, the differentiation of cold panniculitis from cellulitis may be difficult. The absence of systemic symptoms, especially fever, and the history of cold exposure are more suggestive of cold panniculitis.

  2. The lesions may resolve with resulting hyperpigmentation of the affected area.

FIGURE 14.44

Cold Panniculitis. Infant with cheek erythema, swelling, and discoloration consistent with popsicle panniculitis or cold injury. (Photo contributor: Anne W. Lucky, MD.)

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