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Case Report/Case Series |

Ice-Pack Dermatosis:  A Cold-Induced Dermatitis With Similarities to Cold Panniculitis and Perniosis That Histopathologically Resembles Lupus

Sara E. West, MD1; Timothy H. McCalmont, MD2,3; Jeffrey P. North, MD1
[+] Author Affiliations
1Department of Dermatology, University of Missouri, Columbia
2Department of Pathology, University of California, San Francisco
3Department Dermatology, University of California, San Francisco
JAMA Dermatol. 2013;149(11):1314-1318. doi:10.1001/jamadermatol.2013.6302.
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Importance  Cold panniculitis is a self-limited condition, manifesting as erythematous plaques or nodules after cold exposure, that typically affects infants and children. Recently, a variant involving the lateral thighs of equestrians has been described. Since the original report of this variant, some confusion has arisen in the literature in which the terms equestrian cold panniculitis and equestrian perniosis are both used. Outside of this presentation, cold panniculitis in adults is exceedingly rare.

Observations  We describe 2 adult patients using ice-pack therapy for chronic back pain who developed erythematous, purpuric plaques at the site of ice-pack application. Histopathologic findings from both patients were similar and showed overlapping features of perniosis and cold panniculitis that closely resembled the pattern seen in cutaneous lupus erythematosus.

Conclusions and Relevance  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.

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Figure 1.
Clinical and Histopathologic Findings in Patient 1

A, Clinically, patient 1 shows multiple erythematous, purpuric papules with vague retiformlike purpura and focal ulceration on the lower back. B, Histopathologically, there is a superficial and deep perivascular lymphocytic infiltrate involving the neurovascular bundles and adnexa that extends into the superficial subcutis (hematoxylin-eosin, original magnification ×20).

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Figure 2.
Histopathologic Features of Ice-Pack Dermatosis

A, The inflammatory infiltrate has a strong predilection for neurovascular bundles and adnexa in both case1 and case 2 (hematoxylin-eosin, original magnification ×200). B, While a striking dermatitis is present, the lymphocytic infiltrate also extends into the subcutaneous tissue in a lobular-pattern panniculitis in both patients (hematoxylin-eosin, original magnification ×200).

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Figure 3.
Clinical and Histopathologic Findings in Patient 2

A, Clinically, patient 2 shows erythematous, purpuric papules with focal ulceration on the lower lateral back. B, Histopathologically, similar to patient 1, a superficial and deep lymphocytic infiltrate is present involving the neurovascular bundles, adnexa, and superficial subcutis (hematoxylin-eosin, original magnification ×20).

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