Panniculitis


Panniculitis

Description, Causes and Risk Factors:

Inflammation of subcutaneous adipose tissue.

Panniculitis is the term used to describe diseases where the major focus of inflammation is in the subcutaneous tissue. In general, panniculitis presents as erythematous or violaceous nodule in the subcutaneous fat that may be tender or not, that may ulcerate or heal without scarring, and that may be soft or hard on palpation. Thus, the term panniculitis describes a wide spectrum of disease manifestations. The Panniculitis are classified histologically as lobular or septal depending on where the disease process begins. Panniculitis may also be associated with vasculitis or in most cases without vasculitis.

Panniculitis is inflammation of the subcutaneous fat tissue which may result from several different causes. The condition has been associated with various vaccines and injection of other medications including antibiotics. It is thought that the inflammation results from a combination of foreign body and hypersensitivity reactions. Traumatic panniculitis occurs when blunt trauma, chronic pressure, or decreased blood supply are present. Infectious panniculitis occurs when bacteria or deep fungal agents become established in the panniculus. Immune-mediated panniculitis occurs with immune-mediated vascular diseases such as systemic lupus erythematosus and reactions occurring due to drugs, infectious agents, or internal malignancy.

The classification of panniculitis is complicated but, in general, different types can be divided into mostly septal or mostly lobular panniculitis depending on where the microscopic inflammation is most concentrated. In reality, most types of panniculitis have both lobular and septal inflammation. Further classification is based on whether or not there is inflammation involving the blood vessels of the fat

Types:

Septal panniculitis.

1. Erythema nodosum.

2. Necrobiosis lipoidica.

3. Scleroderma.

Lobular panniculitis.

1. Subcutaneous fat necrosis of the newborn.

2. Sclerma neonatorum.

3. Weber-Christian disease.

4. Alpha 1-antityrypish deficiency.

5. Cytophagic histiocytic panniculitis.

6. Panniculitis-like T-cell lymphoma.

7. Pancreatic panniculitis.

8. Lupus panniculitis.

Panniculitis associated with large vessel vasculitis.

1. Cutaneous polyarteritis nodosa.

2. Superficial migratory thrombophlebitis.

Risk Factors:

  • Illness and environmental factors can cause panniculitis. Excessive exposure to extreme cold and trauma are the two typical environmental sometime causes panniculitis. Adults who spend long periods outdoors in the winter and children are especially susceptible. When this occurs, nodules typically appear on the cheeks and forehead.

  • Infections (the most common).

  • Proliferative disorders

  • Connective tissue disease (e.g., SLE, scleroderma).

Symptoms:

Small, red, bumpy nodules that may or may not be painful are the primary symptoms. Tender nodules can break and leak an oily discharge. When the cause is related to an underlying medical condition, weight loss, fever, and fatigue may also be present. Similar to chickenpox, broken panniculitis, nodules can leave red indentations on the affected area.

Diagnosis:

The specific diagnosis of these diseases requires histopathologic study because different panniculitides usually show the same clinical appearance, which consists of subcutaneous erythematous nodules on the lower extremities. However, the histopathologic study of panniculitis is difficult because of an inadequate clinicopathologic correlation, and the changing evolutionary nature of the lesions means that biopsy specimens are often taken from late-stage lesions, which results in nonspecific histopathologic findings.

Although the look and feel of nodules may make doctors suspect a panniculitis diagnosis, a deep skin biopsy is needed to confirm it. Generally performed in a doctor's office under local anesthetic, the procedures involve the doctor cutting out a small wedge of skin and then sending it to a pathology lab for examination.

Treatment:

Because panniculitis sometimes resolves itself, doctors often recommend a "wait and see" approach. Anti-inflammatory medications may also prescribed.

Solitary lesions may be removed surgically. If the panniculitis is due to infectious agents appropriate treatment for the specific agent is administered.

For pancreatic cancer patients undergoing chemotherapy, oral steroids or cancer-related immunosuppressive drugs or antibiotics may be given to reduce panniculitis.

Disclaimer: The above information is just informative purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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