Cold-Induced Dermatoses: Case Report and Review of Literature

Cold panniculitis and perniosis are the most common cold-induced dermatologic disorders and are clinically characterized by indurated and erythematous nodules and plaques that develop at sites exposed to excessive cold and wet conditions. Cold panniculitis is most commonly seen in infants, but adult cases involving the thighs of equestrians are well known and have come to be known as equestrian cold panniculitis or equestrian perniosis. Recently, similar cases have been described in nonequestrian settings with the prolonged use of ice-packs or other cold-therapy devices. We describe the case of 51-year-old female patient who underwent recent arthroscopic shoulder surgery for repair of a rotator cuff tear and presented to the dermatology clinic for painful and erythematous nodules on her arm. A punch biopsy demonstrated a superficial and deep perivascular and periappendageal lymphocytic infiltrate with some spillover into the superficial subcutaneous adipose tissue. Focal vacuolar changes along the basal layer of the epidermis with a few dyskeratotic keratinocytes were present. A mild increase in interstitial mucin was seen, but no significant papillary dermal edema. On clinical questioning she admitted to sustained use of icepacks on the injured shoulder postoperatively for up to 18 hours a day. Based on clinical and histopathologic features the diagnosis of ice-pack dermatosis was made. A review of cold-induced dermatoses is considered with a focus on the main histologic differential diagnoses.