Abstract
A 52-year-old woman presented with 1-week history of an asymptomatic eruption on the right knee. This started as blanched patches which progressed over a few days to raised urticarial papules. Prior to the onset of the eruption, she had been using a cold therapy device on this knee for three weeks after arthroscopy and medial meniscus repair. On examination, there were smooth indurated round papules localized to the right anterior knee. A punch biopsy was obtained revealing a superficial and deep perivascular lymphocytic infiltrate extending into the subcutis, consistent with cold panniculitis. Cold panniculitis refers to inflammation of the fat following exposure to very cold temperatures. It is most common in the cheeks of young children but has rarely been reported in adults, including in female equestrians and after use of ice packs for chronic lower back pain. There has also been a report of cold panniculitis after use of a cold device after shoulder surgery. Treatment frequently involves removing the source of thermal injury. Our patient was instructed to stop using her cold therapy device and over time her lesions resolved. Given the development and increased availability of such devices, it is possible a similar clinical picture may present more frequently in dermatology clinics in the future.
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