Cold panniculitis has been described in children and young women following cold exposure. Histopathologically, cold panniculitis shows a mostly lobular panniculitis, which consists of an infiltrate of lymphocytes and histiocytes in the fat lobules. Usually, the dermis shows a superficial and deep perivascular infiltrate mostly composed of lymphocytes, with no vasculitis. Inflammation is most intense at the dermal-subcutaneous junction. Differential diagnosis of cold panniculitis should be established with subcutaneous fat necrosis of the newborn, sclerema neonatorum, poststeroid panniculitis, chilblains, and frostbites.

1357mucosal lesions have been reported on the mouth, labia majora, and oesophagus. In addition, verrucoid papules infrequently occur, 2 which, when on the genital areas, may resemble warts. Langenbery et al. 2 reviewed the literature and concluded that all verrucoid genital lesions with the histological features of HHD may represent familial benign chronic pemphigus (HHD). The authors thought that this rare clinical entity, verrucoid HHD, was not associated with HPV infection. In our patient, however, verrucoid papules were found on the surface of the erythematous patch clinically, and HPV type 6 DNA was detected in the verrucoid lesions. These findings therefore differ from Langenbery's conclusion. The argument that our patient had condyloma on the genital skin, which happened to have a subclinical anatholytic process of HHD, is unjustified because the base of the verrucoid papules was an erythematous, erosive patch, representing an active lesion of HHD. It seems more likely that our patient had a newly developed HHD lesion superimposed with HPV type 6 infection on the genitalia.The role of infection in inducing lesions of HHD is controversial. 3,4 Herpes virus hominis has been reported to cause a severe exacerbation of HHD. 5 Candidal or bacterial infection may or may not initiate lesions but the subsequent inflammation certainly potentiates acantholysis. 3 On the other hand, some investigators consider that such microbes are secondary invaders rather than primary aetiological agents. 4 In our case, we surmise a possible role of HPV infection in the provocation or induction of skin lesions of HHD. Therefore, biopsy and detection of HPV genome are necessary when verrucoid papules on genital lesions of HHD are encountered.

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