Contact panniculitis from ice in an adult woman

Cold panniculitis is an inflammatory disease of the subcutaneous tissue induced by cold exposure. It is usually observed during the cold season on the cheeks and/or chin of infants, probably favoured by the peculiar chemical composition of their subcutaneous fat. Adults are rarely affected, though the condition has been reported to occur in obese women, particularly at the thighs, in association with sport induced micro-traumas. We describe a 43-year-old lady who was referred for an ice cube test with the suspicion of cold urticaria. She reported developing an erythemato-oedematous burning plaque at the inner aspect of her left thigh 24 hours after the application of an ice pack for a trauma. The lesion resolved in 3 weeks with residual hyperpigmentation. An ice cube test performed at the right knee was negative at 15 mins and 24 hrs but induced an inflamed, painful plaque after 72 hrs. Hystology revealed lobular panniculitis. The clinical and hystological pictures were consistent with the diagnosis of cold panniculitis. This case is quite unusual considering the age of the patient and the triggering factor.