From the Guidelines
Panniculitis is a severe inflammation of the subcutaneous fat, characterized by painful, tender lumps or nodules under the skin, which can be caused by various factors including alpha-1 antitrypsin deficiency, infections, medications, autoimmune disorders, trauma, or cold exposure. This condition can manifest in different forms, such as erythema nodosum, lupus panniculitis, and pancreatic panniculitis, with symptoms including redness, swelling, tenderness, fever, joint pain, or fatigue 1. The diagnosis of panniculitis often requires a skin biopsy to determine the specific type and guide appropriate treatment, which may include anti-inflammatory medications, antibiotics, or immunosuppressants, depending on the underlying cause 1.
Causes and Types of Panniculitis
- Alpha-1 antitrypsin deficiency-associated panniculitis, a rare but well-recognized complication, characterized by necrotizing lesions of skin and subcutaneous tissue 1
- Infection-induced panniculitis, which may require antibiotic treatment
- Medication-induced panniculitis, where stopping the offending drug is typically necessary
- Autoimmune disorder-related panniculitis, such as lupus panniculitis
- Trauma or cold exposure-induced panniculitis
Treatment and Management
- Augmentation therapy with purified human alpha-1 antitrypsin or fresh frozen plasma may be effective in treating alpha-1 antitrypsin deficiency-associated panniculitis 1
- Anti-inflammatory medications, such as NSAIDs or corticosteroids, may be used to manage symptoms
- Antibiotics may be necessary for infection-induced panniculitis
- Immunosuppressants may be used in cases of autoimmune disorder-related panniculitis
- Dapsone may be of additional value in treating alpha-1 antitrypsin deficiency-associated panniculitis, although its mechanism of action is unclear 1
Prognosis and Outcome
- The prognosis of panniculitis varies depending on the underlying cause and the presence of other complications, such as cirrhosis or emphysema in alpha-1 antitrypsin deficiency-associated panniculitis 1
- Early diagnosis and treatment are crucial to prevent long-term morbidity and mortality 1
From the Research
Definition of Panniculitis
- Panniculitis is characterized as inflammation of the subcutaneous fat [(2,3,4,5,6)].
- It is a relatively uncommon condition that usually presents with inflammatory nodules or plaques 2.
Types of Panniculitis
- Panniculitis can be categorized into septal or lobular subtypes [(3,5,6)].
- Other histopathological features, such as the presence of vasculitis, nature of inflammatory infiltrates, and characteristics of fat necrosis, are also important for diagnostic purposes [(3,5,6)].
Clinical Presentation
- Clinically, panniculitis is characterized by the presence of subcutaneous nodules 3.
- Both ulcerative and nonulcerative clinical subtypes have been proposed 3.
- Erythema nodosum is the most common clinical form of panniculitis [(2,3,6)].
Associated Conditions
- Panniculitis can be associated with various conditions, including infections, drugs, systemic illnesses, pregnancy, and malignancy 2.
- It is also a distinctive feature in certain autoinflammatory disorders, such as proteasome-associated autoinflammatory syndromes (PRAAS) 3.
- Panniculitis can identify a specific subgroup of patients with autoinflammatory disorders and may potentially be regarded as a cardinal sign of autoinflammation 3.