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