Forum for Nordic Dermato-Venereology Nr 1, 2018 | Page 31

Kim Røed Pedersen, Carsten Suer Mikkelsen and L. Penninga – Cold panniculitis in a child (Haxthausen’s disease) and horse riders pernio
Cold-induced pernio has also been reported in cyclists, motor-
ists, milk-delivery men, golf-buggy drivers, and, in the context
of other outdoor activities practised in cold, wet and windy
conditions (14), in both males and females (15). Pernio of
the hips in young girls wearing tight-fitting jeans with a low
waistband is also described in case-report (12).
Diagnosis and treatment
Cold panniculitis is a clinical diagnosis. There is no need for
biopsy. The condition is treated conservatively. Firm evidence
for proper treatment of cold panniculitis is lacking.
There is no need for antibiotic treatment. There is no sim-
ple method to treat or prevent cold panniculitis, except for
dressing warmly.
Nifedipine, a calcium antagonist, is sometimes recommend-
ed for treatment, but the evidence to support its use is not
convincing (16, 17). Topically steroids (typically group II)
can reduce symptoms, but the evidence is poor. Typically the
lesions are gone within one month without any treatment.
References
1. Hultcrantz E. Haxthausens disease. Cold panniculitis in children.
J Laryngol Otol 1986; 100: 1329–1332.
2. Hultcrantz E. [Haxthausens pannikulitis – a childhood disese to
be aware of in cold winter.] Läkartidningen 1985; 82: 4427 (in
Swedish).
3. Diamantis S, Bastek T, Groben P, Morrell D. Subcutaneous fat
necrosis in a newborn following icebag application for treatment
of supraventricular tachycardia. J Perinatol 2006; 26: 518–520.
4. Casado-Jimenez M. Cold panniculitis. Dermatol Clin 2008; 26:
485–489.
5. Bygum A. Picture of the month. Ugeskrift for læger 173/6 7.
February 2011.
6. Haxthausen H. Adiponecrosis e frigore. Br J Dermatol 1941; 53:
83–89.
7. Beacham B, Cooper P, Buchanan G, Peyton E, Weary M. Equestrian
cold panniculitis in women. Arch Dermatol 1980; 116: 1025–1027.
8. Pekki A. Cold pannicultis in Finnish horse riders. Acta Derm Ve-
nereol 2011; 91: 463–464.
9. Crowson A, Magro C. Idiopathic perniosis and its mimics: a
clinical and histological study of 38 cases. Human Pathol 1997;
28: 478–484.
10. Vickers H, Bleehen S. Equestrian cold panniculitis in women. Arch
Dermatol 1981; 117: 315–316.
11. Stam F, van Meurs T, Koley C. Between hands and feet. Neth J Med
2005; 11: 447–448.
12. Weismann K, Larsen F. Pernio of the hips in young girls wearing
tight-fitting jeans with a low waistband. Acta Derm Venereol
2006; 86: 558–559.
13. Quesada-Cortes A, Campos-Munos L, Diaz-Diaz R, Casado-Jimenez
M. Cold panniculitis. Dermatol Clin 2008; 26: 485–489.
14. Price R, Murdoch D. Perniosis (chilblains) of the thigh: report of
five cases, including four following river crossings. High Alt Med
Biol 2001; 4: 535–538.
15. Vickers H, Bleehen S. Equestrian cold panniculitis in women. Arch
Dermatol 1981; 117: 315–316.
16. De Silva BD, McLaren K, Doherty Editorial. Winter kibes in horsey
women. Lancet 1980; 2: 1345.
17. Teixeira F, Punjabi S, Dadzie O, Charakida E, Chu AC. The hazards
of horse riding. Aust Fam Physician 2005; 34: 369–370.
Answers to CME on page 30–31
Case 9: 3 (starburst and globular pigment patterns, uniform negative network)
Case 10: 2 (streaming, pseudopods, blue-white areas)
Case 11: 2 (sharply dermarcated red lagoons)
Case 12: 2 (abnormal pigment network at the periphery, ”bird´s nests”)
Forum for Nord Derm Ven 2018, Vol. 28, No. 1
C ase R eport
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