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To the Editor.—I agree that it is remarkable that only a few of the large number of children exposed to cold develop cold panniculitis. Pressure from a drawstring to a hood or cap plays a negligible role, if any, in the distribution pattern of the induration. As I pointed out in my paper, an infant exposed generally to cold develops generalized induration. The lesion can be reproduced on the forearm of the patient by the brief application of ice without pressure. It is difficult to conceive of pressure from a drawstring producing a circular zone of ischemia in the cheeks, sometimes unilaterally. Some of the patients did not have a drawstring, but merely a loose cloth strap attached to the hood. The distribution pattern can be more effectively explained by the pattern of infants' winter clothing, in which only the face is generally directly exposed to cold, and by
L. B. LOWE. COLD PANNICULITIS-Reply. Am J Dis Child. 1968;116(6):687–688. doi:10.1001/archpedi.1968.02100020691029