From the Guidelines
Panniculitis is a distinct form of inflammation of the subcutaneous fatty tissue, characterized by painful, hot, red, tender nodules that can lead to ulcerations and drainage of a clear, yellow, oily fluid, as seen in alpha-1 antitrypsin deficiency-associated panniculitis 1.
Definition and Causes
Panniculitis can result from various causes, including infections, medications, autoimmune disorders, trauma, or cold exposure, and can present with redness, tenderness, and sometimes ulceration of the affected areas.
- The condition can be acute or chronic and may affect any part of the body where fat is present.
- Different types of panniculitis exist, such as erythema nodosum, lupus panniculitis, and pancreatic panniculitis.
Diagnosis and Treatment
Treatment depends on the underlying cause and may include addressing the primary condition, anti-inflammatory medications like NSAIDs or corticosteroids, and supportive measures such as rest and elevation of affected limbs 1.
- In severe cases, immunosuppressive drugs might be necessary, and augmentation therapy with purified human AAT or fresh frozen plasma may be considered for alpha-1 antitrypsin deficiency-associated panniculitis.
- Dapsone, either alone or combined with augmentation therapy, may also be of additional value in treating panniculitis, although its mechanism of action is unclear 1.
Prognosis and Management
Understanding the specific type of panniculitis is crucial for effective management, as treatment approaches vary based on the underlying cause and severity of inflammation.
- The prognosis in patients with panniculitis can be variable and partly dependent on the presence of other complications, such as cirrhosis or emphysema in the case of alpha-1 antitrypsin deficiency-associated panniculitis 1.
- Family screening and antismoking counseling are essential for individuals with alpha-1 antitrypsin deficiency, and restoration of plasma AAT levels after liver transplantation may lead to permanent cure in some cases 1.
From the Research
Definition of Panniculitis
- Panniculitis is an inflammation of the subcutaneous fat 2, 3, 4, 5, 6
- It can be categorized into septal or lobular subtypes based on histopathological features 2, 3, 5
Clinical Presentation
- Characterized by the presence of subcutaneous nodules, with both ulcerative and nonulcerative clinical subtypes 3
- Tender, erythematous subcutaneous nodules are the most typical clinical finding 4
Diagnosis
- Skin biopsy plays a critical role in the differential diagnosis of panniculitis 2
- Histopathologic study is necessary to confirm the diagnosis, with differentiation between predominantly septal or lobular panniculitis, and presence or absence of vasculitis 2, 5
- Clinical clues can aid in diagnosis, but pathology is often necessary to confirm the diagnosis 4
Types of Panniculitis
- Septal panniculitis: includes erythema nodosum, necrobiosis lipoidica, and cutaneous polyarteritis nodosa 5
- Lobular panniculitis: includes sclerosing panniculitis, calciphylaxis, and lupus erythematosus profundus 5
- Other types: include cytophagic histiocytic panniculitis, lipoatrophic panniculitis of children, and otulipenia 3
Treatment
- Treatment can be challenging and is based on the histopathological findings 2
- Frequently, the precise cause of panniculitis cannot be established from the outset, so it is important to follow-up patients and not hesitate to repeat the skin biopsy 2
- Treatment depends upon eliminating the underlying cause in addition to using anti-inflammatory and immunosuppressive agents 6