Popsicle Panniculitis

The Dangerous Popsicle!


Many management algorithms in the Pediatric ED have “Administration of Ice Popsicle” as the main nodal decision point and therapeutic maneuver.  Some days I feel like a drug dealer as I continually offer free Ice Pops to the little kidos {maybe this is why we have so many return customers in our pediatric ED… hmm}.  But before we over-state the low-risk cure-it-all, let’s just consider one potential complication with the beloved Ice Pop: Popsicle Panniculitis.


Popsicle Panniculitis: Basics

  • Cold / Popsicle Panniculitis is inflammation of the subcutaneous fat after prolonged exposure to cold.
  • Perhaps it is more commonly seen in younger children because they have a higher percentage of saturated fatty acids than older kids and adults (or because they don’t now how to eat an Ice Pop correctly!).

Popsicle Panniculitis: Clinical Features

  • Red or darkened skin color
  • Warmth
  • Induration – occasionally you can detect discrete nodules or plaques
  • Typically located in perioral locations
  • May occur within a few hours of exposure, or not be detected for 1-2 days.


Popsicle Panniculitis: Management

  • Supportive
  • Eliminate further cold exposure (maybe the kid will drink Jello-Water instead)
  • Consequences
    • Typically resolves in 2-3 weeks
    • Usually without scaring, but there are case reports of Dimples developing in that associated cheek.
    • Hyperpigmentation can remain.


Popsicle Panniculitis: Other Considerations

  • Just in case you are wrong… think about:
    • Frostbite
    • Systemic Lupus Erythematosus
    • Scleroderma
    • Cellulitis


Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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