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Panniculitis
Erythema induratum, a form of lobular panniculitis
Specialty
Rheumatology
Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue (the fatty layer under the skin – panniculus adiposus).[1] Symptoms include tender skin nodules, and systemic signs such as weight loss and fatigue.
Restated, an inflammatory disorder primarily localized in the subcutaneous fat is termed a "panniculitis", a group of disorders that may be challenging both for the clinician and the dermatopathologist.[2]:487
Contents
1Signs and symptoms
1.1Associated conditions
2Diagnosis
2.1Classification
2.1.1Lobular
2.1.1.1With vasculitis
2.1.1.2Without vasculitis
2.1.2With needle-shaped clefts
2.1.3Septal
2.1.3.1Erythema nodosum
2.1.3.2A1AT-deficiency-associated
3Treatment
4See also
5References
6External links
Signs and symptoms
Panniculitis can also be classified based on the presence or absence of systemic symptoms. Panniculitis without systemic disease can be a result of trauma or cold.[3] Panniculitis with systemic disease can be caused by[citation needed]:
connective tissue disorders such as lupus erythematosus or scleroderma;
lymphoproliferative disease such as lymphoma or histiocytosis;
pancreatitis or pancreatic cancer;
sarcoidosis with cutaneous involvement (seen in up to 20 percent);
Alpha 1-antitrypsin deficiency
Crohn's disease
This is not a complete list of possible causes.
Associated conditions
Lipoatrophy or lipodystrophy (the loss of subcutaneous adipose tissue) can occur in any of these conditions.
Diagnosis
Classification
It can occur in any fatty tissue (cutaneous or visceral) and is often diagnosed on the basis of a deep skin biopsy, and can be further classified by histological characteristics based on the location of the inflammatory cells (within fatty lobules or in the septa which separate them) and on the presence or absence of vasculitis.
There are thus four main histological subtypes:[4]
Erythema induratum, or "Bazin disease", is a panniculitis on the back of the calves.[6] It was formerly thought to be a reaction to the tuberculum bacillus. It is now considered a panniculitis that is not associated with a single defined pathogen.[7]
Nodular vasculitis is a skin condition characterized by small, tender, reddened nodules on the legs, mostly on the calves and shins. Microscopically there are epithelioid granulomas and vasculitis in the subcutaneous tissue, making it a form of panicullitis. Most of these cases are now thought to be manifestation of tuberculosis and indeed they respond well to anti-tuberculous treatment.[citation needed]
Without vasculitis
Non-vasculitis forms of panniculitis that may occur include:
Cytophagic histiocytic panniculitis was first described in 1980 by Winkelmann as a chronic histiocytic disease of the subcutaneous adipose tissue, which is characterized clinically by tender erythematous nodules, recurrent high fever, malaise, jaundice, organomegaly, serosal effusions, pancytopenia, hepatic dysfunction and Coagulation abnormalities.[2]:494[8] CHP may occur either isolated or as part of cutaneous manifestations of Hemophagocytic syndrome (HPS).[9] CHP is a rare and often fatal form of panniculitis with multisystem involvement. But it can also present in a benign form involving only the subcutaneous tissue, thus having a broad clinical spectrum.
Traumatic panniculitis is a panniculitis that occurs following trauma to the skin.[2]:492[10]
Cold panniculitis is a panniculitis occurring after exposure to cold, most often seen in infants and young children.[2]:491 This condition has been described in children who suck ice or popsicles, and therefore is sometimes referred to as "popsicle panniculitis."[2]:491[10] The term was coined when a patient with a rash of unknown origin on her cheek was taken to a dermatologist.[11]
Gouty panniculitis is a panniculitis caused by deposition of uric acid crystals in gout.[2]:494
Pancreatic panniculitis (also known as "Enzymatic panniculitis," "Pancreatic fat necrosis,"[10] and "Subcutaneous fat necrosis") is a panniculitis most commonly associated with pancreatic carcinoma, and more rarely with anatomic pancreatic abnormalities, pseudocysts, or drug-induced pancreatitis.[2]:493
Factitial panniculitis is a panniculitis that may be induced by the injection of organic materials, povidone, feces, saliva, vaginal fluid, and oils.[2]:492
With needle-shaped clefts
Lipodermatosclerosis is a form of panniculitis associated with chronic venous insufficiency that presents with brown indurations on the front of the shins. It may be associated with pain and other signs of chronic venous insufficiency. The exact cause is unknown.[12]
Other forms include:
Subcutaneous fat necrosis of the newborn, a form of panniculitis occurring in newborns that is usually self-resolving, that may be a result of hypoxic injury to relatively high levels of brown fat.[2]:492
Weber–Christian disease, a symmetrical form of the disease of unknown origin occurring in middle-aged women.[2]:492
Lupus erythematosus panniculitis, panniculitis associated with lupus erythematosus.[13]
Forms associated with use of high doses of systemic corticosteroids during rapid corticosteroid withdrawal, and from the injection of silicone or mineral oils.[2]:492
Septal
Erythema nodosum
Main article: Erythema nodosum
Erythema nodosum is a form of panniculitis characterised by tender red nodules, 1–10 cm, associated with systemic symptoms including fever, malaise, and joint pain. Nodules may become bluish-purple, yellowing, and green, and subside over a period of 2–6 weeks without ulcerating or scarring. Erythema nodosum is associated with infections, including Hepatitis C, EBV and tuberculosis, Crohn's disease and sarcoidosis, pregnancy, medications including sulfonamides, and some cancers, including Non-Hodgkin lymphoma and pancreatic cancer.[14]
A1AT-deficiency-associated
See also: Alpha-1 antitrypsin deficiency
Alpha-1 antitrypsin deficiency panniculitis [13] is a panniculitis associated with a deficiency of the α1-antitrypsin enzyme.[2]:494
Treatment
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See also
Panniculus carnosus
List of cutaneous conditions
References
^"panniculitis" at Dorland's Medical Dictionary
^ abcdefghijklmJames, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
^"eMedicine - Weber-Christian Disease : Article by Moise L Levy". Retrieved 2008-03-25.
^"erythema induratum" at Dorland's Medical Dictionary[dead link]
^Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. p. 1265. ISBN 978-0-7216-0187-8.
^Winkelmann RK, Bowie EJ. Hemorrhagic diathesis associated with benign histiocytic cytophagic panniculitis and systemic histiocytosis. Arch Intern Med.1980; 140: 1460-3
^Smith K J, Skeleton H J, Yeagre J, Angritt P, Wagner K, James W. D., Giblin W. J., Lupton G. P. Cutaneous histopathological, immunohistochemical, and clinical manifestations inpatients with hemophagocytic syndrome. Military Medical old Consortium for Applied Retroviral Research (MMCARR). Arch Dermatol 1992; 128: 193-200
^ abcRapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 1515. ISBN 978-1-4160-2999-1.
^Epstein, Ervin and Oren, Mark, "Popsicle Panniculitis" "The New England Journal of Medicine", 282 (17) : 966-67, 1970
^Bruce AJ. et al., Lipodermatosclerosis: Review of cases evaluated at Mayo Clinic. J Am Acad Dermatol. 2002.
^ abRapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
with vasculitis: Nodular vasculitis/Erythema induratum
Septal
without vasculitis: Alpha-1 antitrypsin deficiency panniculitis
Erythema nodosum
Acute
Chronic
with vasculitis: Superficial thrombophlebitis
Lipodystrophy
Acquired
generalized: Acquired generalized lipodystrophy
partial: Acquired partial lipodystrophy
Centrifugal abdominal lipodystrophy
HIV-associated lipodystrophy
Lipoatrophia annularis
localized: Localized lipodystrophy
Congenital
Congenital generalized lipodystrophy
Familial partial lipodystrophy
Marfanoid–progeroid–lipodystrophy syndrome
Poland syndrome
v
t
e
Inflammation
Acute
Plasma-derived mediators
Bradykinin
complement
C3
C5a
MAC
coagulation
Factor XII
Plasmin
Thrombin
Cell-derived mediators
preformed:
Lysosome granules
biogenic amines
Histamine
Serotonin
synthesized on demand:
cytokines
IFN-γ
IL-8
TNF-α
IL-1
eicosanoids
Leukotriene B4
Prostaglandins
Nitric oxide
Kinins
Chronic
Macrophage
Epithelioid cell
Giant cell
Granuloma
Processes
Traditional
Rubor
Calor
Tumor
Dolor
Functio laesa
Modern
Acute-phase reaction/Fever
Vasodilation
Increased vascular permeability
Exudate
Leukocyte extravasation
Chemotaxis
Specific locations
Nervous
CNS
Encephalitis
Myelitis
Meningitis
Arachnoiditis
PNS
Neuritis
eye
Dacryoadenitis
Scleritis
Episcleritis
Keratitis
chorioretinitis
Retinitis
Chorioretinitis
Blepharitis
Conjunctivitis
Uveitis
ear
Otitis externa
Otitis media
Labyrinthitis
Mastoiditis
Cardiovascular
Carditis
Endocarditis
Myocarditis
Pericarditis
Vasculitis
Arteritis
Phlebitis
Capillaritis
Respiratory
upper
Sinusitis
Rhinitis
Pharyngitis
Laryngitis
lower
Tracheitis
Bronchitis
Bronchiolitis
Pneumonitis
Pleuritis
Mediastinitis
Digestive
mouth
Stomatitis
Gingivitis
Gingivostomatitis
Glossitis
Tonsillitis
Sialadenitis/Parotitis
Cheilitis
Pulpitis
Gnathitis
tract
Esophagitis
Gastritis
Gastroenteritis
Enteritis
Colitis
Enterocolitis
Duodenitis
Ileitis
Caecitis
Appendicitis
Proctitis
accessory
Hepatitis
Ascending cholangitis
Cholecystitis
Pancreatitis
Peritonitis
Integumentary
Dermatitis
Folliculitis
Cellulitis
Hidradenitis
Musculoskeletal
Arthritis
Dermatomyositis
soft tissue
Myositis
Synovitis/Tenosynovitis
Bursitis
Enthesitis
Fasciitis
Capsulitis
Epicondylitis
Tendinitis
Panniculitis
Osteochondritis: Osteitis/Osteomyelitis
Spondylitis
Periostitis
Chondritis
Urinary
Nephritis
Glomerulonephritis
Pyelonephritis
Ureteritis
Cystitis
Urethritis
Reproductive
female
Oophoritis
Salpingitis
Endometritis
Parametritis
Cervicitis
Vaginitis
Vulvitis
Mastitis
male
Orchitis
Epididymitis
Prostatitis
Seminal vesiculitis
Balanitis
Posthitis
Balanoposthitis
pregnancy/newborn
Chorioamnionitis
Funisitis
Omphalitis
Endocrine
Insulitis
Hypophysitis
Thyroiditis
Parathyroiditis
Adrenalitis
Lymphatic
Lymphangitis
Lymphadenitis
UpToDate Contents
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1. 脂肪織炎：認識および診断 panniculitis recognition and diagnosis
2. 新生児皮下脂肪壊死症 subcutaneous fat necrosis of the newborn
3. 皮下蜂窩織炎様T細胞性リンパ腫の臨床症状、病理学的特徴、および診断 clinical manifestations pathologic features and diagnosis of subcutaneous panniculitis like t cell lymphoma
4. 下腿潰瘍の鑑別診断アプローチ approach to the differential diagnosis of leg ulcers
5. 皮膚エリテマトーデスの概要 overview of cutaneous lupus erythematosus
English Journal
Stratifying Minimal Versus Severe Pain in Knee Osteoarthritis Using a Musculoskeletal Ultrasound Protocol.
Bernardo-Bueno MM, Gonzalez-Suarez CB, Malvar AK, Cua R, Feliciano D, Tan-Sales BG, Aycardo SMO, Tan-Ong M, Chan R, De Los Reyes F.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2019 Jun;38(6)1411-1423.
The aim of this cross-sectional correlational study was to determine the association of pain with morphologic and inflammatory sonographic findings in patients with knee osteoarthritis. A total of 113 participants with knee osteoarthritis were assessed using visual analog scale pain score and sonogr
Mycobacterium nebraskense infection in a dog in Switzerland with disseminated skin lesions.
Timm K, Welle M, Friedel U, Gunn-Moore D, Peterhans S.
Veterinary dermatology. 2019 Jun;30(3)262-e80.
Cutaneous disseminated mycobacteriosis is rare in dogs. To the best of the authors' knowledge, the slowly growing mycobacterial species Mycobacterium nebraskense has not been described before in this species. Description of clinical features, laboratory analyses and treatment regimen of this unusual
INTRODUCTION Panniculitis (inflammation of the subcutaneous fat) is a relatively uncommon condition that usually presents with inflammatory nodules or plaques. A wide variety of subtypes of panniculitis exist, including ...
nodular nonsuppurative panniculitis , relapsing febrile nodular nonsuppurative panniculitis a disease marked by fever and the formation of crops of tender ... a chronic inflammation of subcutaneous fat in which the skin becomes ...
