Ice-Pack Dermatosis

Abstract

Ice-pack dermatosis is an uncommon cold-induced process that occurs in adults using long-term ice-pack therapy. The clinical manifestations include erythematous to purpuric plaques with a livedolike appearance and superficial ulceration. The histopathologic features resemble those seen in cutaneous lupus erythematosus with a superficial and deep perivascular and periadnexal dermatitis with increased dermal mucin and a superficial lobular panniculitis.

Cold‐associated perniosis of the thighs histopathologically mimicking lupus. Six observations

“…Cases of cold‐induced dermatoses clinically similar to cold panniculitis or chilblains, but histologically resembling lupus have been reported in horse riders or patients using ice‐pack therapy for lumbar pain . In those reports, the authors depict histological findings similar to our patients' biopsies, combining a superficial and deep dermal lymphocytic infiltrate and mucin deposition.…”

“…In some cases, the presence of cold agglutinins was reported . More generally speaking, cold‐induced dermatoses appear in a variety of settings, either during outdoor activities in cold or humid environment, especially if chronic pressure due to tight‐fitting clothes or shoes, or following the application of ice packs or cryotherapy systems …”

“…In those reports, the authors depict histological findings similar to our patients' biopsies, combining a superficial and deep dermal lymphocytic infiltrate and mucin deposition. Immunohistochemistry using anti‐CD123 antibody to highlight plasmacytoid dendritic cells within the lymphocytic infiltrate, such as described in Jessner‐Kanof disease or in lupus, does not seem useful to distinguish cold‐related dermatoses from lupus, and shows that similar cellular effectors are involved in these diseases. Recently, a series of six cases of cold‐associated perniosis of the thighs (‘equestrian‐type chilblain’) has been published .…”

“…5 More generally speaking, cold-induced dermatoses appear in a variety of settings, either during outdoor activities in cold or humid environment, especially if chronic pressure due to tight-fitting clothes or shoes, or following the application of ice packs or cryotherapy systems. [14][15][16][17][18][19][20] There seems to be a nosological problem because of the diversity of the denominations used for this pathology (rider's pernio, equestrian perniosis, equestrian cold panniculitis, chilblains of the thigh, etc.). We agree with Ferrara and Cerroni and choose to use for this disease presentation the term 'cold-associated perniosis of the thighs' which seems more accurate, as a panniculitis is not always present and because it is now reported in other types of cold exposures.…”

Firm Erythematous Nodules in a Hospitalized Infant

“…Cold panniculitis is a self‐limiting condition, with neonates and infants up to 6 months old most susceptible. In adults it occurs most commonly in female equestrians on the thighs and buttocks and in individuals who use ice pack therapy for chronic pain . Cold panniculitis was first described over a century ago in children exposed to cold temperatures and is commonly recognized on the cheeks of children with a history of eating popsicles, due to direct contact with the buccal mucosa (popsicle panniculitis) .…”