I M A G E S Cold Panniculitis Neonatorum R G HOLLA AND *AMARENDRA NARAYAN PRASAD Military Hospital, 166 MH, Jammu; and *Department of Pediatrics, Military Hospital, Namkum, Ranchi 834 010, India. E-mail : [email protected] ocalised areas of erythema and induration play a role in its causation. The eruptive phase usu- developed on the feet of 2 term neonates ally begins 48 (6-72) hours after a cold injury to ex- (male and a female) on the 7th and 10th posed or poorly protected areas. Lesions present as Lday of life respectively, at the peak of win- localized indurated nodules with ill-defined margins. ters in the plains of North Nodules are firm or hard India. There were no pre- and cold and painful. ceding perinatal risk fac- Cutaneous distribution tors or complications. in children characteristi- The babies had no direct cally is on the face exposure to any cold ob- (cheeks and forehead) ject or ice. Woody and extremities (feet and erythema was noted first, hand). Cold panniculitis followed by (24 to 48 neonatorum should be hrs) formation of red- differentiated from purple nodules. Gradual sclerema neonatorum, rewarming was done poststeroid panniculitis over a period of days, and and chill blains. Biopsy both babies had complete is reserved for diagnos- recovery. tic problem cases. The Cold panniculitis classic features of cold neonatorum, also called panniculitis on histopa- adiponecrosis subcu- thology predominantly tanea is an acute, nodu- are a lobular panniculi- lar, erythematous erup- tis with scattered tion usually limited to ar- lympho histiocytic and eas exposed to the cold in eosinophilic infiltrates. the full-term newborn. Cold Panniculitis neo- Cold panniculitis results natorum is a self-limit- FIG. 1 Newborn with cold panniculitis involving left foot. from a cold injury to sub- ing disorder (resolves cutaneous adipose tissue, which leads to inflamma- within few weeks) and requires only symptomatic tion of the adipose tissue. Anoxia, cold, and humidity relief and slow rewarming. INDIAN PEDIATRICS 75 VOLUME 46__JANUARY 17, 2009.