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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 The general term for inflammation of any adipose tissue is steatitis.
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]:
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.[citation needed]
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 panniculitis. 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 subcutaneousadipose tissue, which is characterized clinically by tender erythematousnodules, 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
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 [14]
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.[15]
^ abcdefghijklmJames, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN978-0-7216-2921-6.
^"eMedicine - Cold Panniculitis: Article by Geromanta Baleviciene". Retrieved 2008-03-25.
^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. ISBN978-0-7216-0187-8.
^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. ISBN978-1-4160-2999-1.
^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. ISBN978-1-4160-2999-1.
^Garg, Taru; Ahmed, Riaz; Bharadwaj, Apoorva V.; Shukla, Shailaja (April 2022). "Poststeroid panniculitis – A rare case report". Indian Journal of Paediatric Dermatology. 23 (2): 165.
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This article needs more medical references for verification or relies too heavily on primary sources Please review the contents of the article and add the appropriate references if you can Unsourced or poorly sourced material may be challenged and removed Find sources Panniculitis news newspapers books scholar JSTOR December 2018 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 PanniculitisErythema induratum a form of lobular panniculitisSpecialtyRheumatology 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 The general term for inflammation of any adipose tissue is steatitis Contents 1 Signs and symptoms 1 1 Associated conditions 2 Diagnosis 2 1 Classification 2 1 1 Lobular 2 1 1 1 With vasculitis 2 1 1 2 Without vasculitis 2 1 2 With needle shaped clefts 2 1 3 Septal 2 1 3 1 Erythema nodosum 2 1 3 2 A1AT deficiency associated 3 Treatment 4 See also 5 References 6 External linksSigns and symptoms EditPanniculitis 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 diseaseThis is not a complete list of possible causes Associated conditions Edit Lipoatrophy or lipodystrophy the loss of subcutaneous adipose tissue can occur in any of these conditions citation needed Diagnosis EditClassification Edit 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 citation needed There are thus four main histological subtypes 4 lobular panniculitis without vasculitis acute panniculitis previously termed Weber Christian disease 5 systemic nodular panniculitis lobular panniculitis with vasculitis septal panniculitis without vasculitis septal panniculitis with vasculitisLobular Edit With vasculitis Edit 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 panniculitis 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 Edit 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 Edit 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 Sclerema neonatorum affecting premature births 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 14 Septal Edit Erythema nodosum Edit 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 15 A1AT deficiency associated Edit See also Alpha 1 antitrypsin deficiency Alpha 1 antitrypsin deficiency panniculitis 13 is a panniculitis associated with a deficiency of the a1 antitrypsin enzyme 2 494 Treatment EditThis section is empty You can help by adding to it December 2017 See also EditPanniculus carnosus List of cutaneous conditionsReferences Edit panniculitis at Dorland s Medical Dictionary a b c d e f g h i j k l m James William D Berger Timothy G et al 2006 Andrews Diseases of the Skin clinical Dermatology Saunders Elsevier ISBN 978 0 7216 2921 6 eMedicine Cold Panniculitis Article by Geromanta Baleviciene Retrieved 2008 03 25 Panniculitis DermNet NZ Retrieved 2010 05 17 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 a b c Rapini 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 a b Rapini Ronald P Bolognia Jean L Jorizzo Joseph L 2007 Dermatology 2 Volume Set St Louis Mosby ISBN 978 1 4160 2999 1 Garg Taru Ahmed Riaz Bharadwaj Apoorva V Shukla Shailaja April 2022 Poststeroid panniculitis A rare case report Indian Journal of Paediatric Dermatology 23 2 165 Gilchrist H Patterson JW Jul Aug 2010 Erythema nodosum and erythema induratum nodular vasculitis diagnosis and management Dermatologic Therapy 23 4 320 7 doi 10 1111 j 1529 8019 2010 01332 x PMID 20666819 S2CID 39695627 External links EditDermNet dermal infiltrative panniculitisDermAtlas 639418194 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