Case Report
Cold Panniculitis in a Child( Haxthausen’ s Disease) and Horse Riders Pernio
Kim Røed Pedersen 1, Carsten Sauer Mikkelsen 1 and Luit Penninga 2
1
Clinic of Dermatology, Broenderslev, Denmark, and 2 Ilulissat Hospital, Ilulissat, Greenland. E-mail: c. s. mikkelsen @ hotmail. com
Case 1
Cold panniculitis: A 6 – month-old infant developed cold panniculitis with red indurated nodules and plaques on both of his cheeks( Fig. 1). The condition was caused by exposure to severe cold weather, as he was outside for several hours in extreme cold and windy weather in a kindergarten in Ilulissat, Northern Greenland in December.
Case: 2
Horse rider pernio. A 23-year-old woman was working in the northern part of Sweden for a stable owner. She was riding horses 6 – 8 times daily in very low temperatures. She was always wearing riding breeches. Suddenly she developed a slightly itchy rash on both her thighs( Fig. 2). The rash lasted for approximately 2 weeks. She recovered without sequelae.
Discussion
These two case reports describe the rarely recognized, but probably quite common condition cold panniculitis. Cold panniculitis is an acute, nodular, erythematous eruption usually limited to cold-exposed areas, which occurs predominantly in infants( 1, 2). been associated with ice pack application( 3). It results from a cold injury to adipose tissue causing inflammation and necrosis( 4, 5). Furthermore, there is supposed to be a vascular injury component which causes the condition.
Cold panniculitis was first described by the Danish dermatologist, Holger Haxthausen, in 1941( 6). No racial predilection is known. During childhood and infancy, an equal incidence exists for both sexes.
The type equestrian cold panniculitis also called horse rider’ s pernio or equestrian panniculitis was first described by Beacham et al.( 7). Cold panniculitis in horse riders is a rare phenomenon( 8). Localized chilling of the tissues of the thigh, buttocks, and lower abdomen is more likely to occur in women who are obese. It occurs predominantly during the winter months because of increased cold exposure.
Heavy smoking, age less than 35 years and tight clothes worn for many hours were associated with skin symptoms( 9, 10). Most published reports present only a few patients( 11 – 13).
In infants, the cheeks and forehead are areas that predominantly are affected. Cold panniculitis of the newborn has also
Fig. 1. A 6-month-old infant with cold panniculitis. Fig. 1. A 23-year-old woman with horse rider pernio.
28 Forum for Nord Derm Ven 2018, Vol. 23, No. 1