From the Guidelines
Panniculitis should be treated with dapsone, either alone in less severe cases, or combined with augmentation therapy, as it may be of additional value in managing the condition. The diagnosis of panniculitis involves identifying the underlying cause of the inflammation, which can be due to various factors such as infections, medications, autoimmune conditions, or trauma 1.
Key Considerations
- Panniculitis presents as painful, tender nodules or plaques, typically on the legs, though it can occur anywhere on the body.
- Biopsy-proven severe panniculitis is a serious condition that requires prompt treatment 1.
- Augmentation therapy with purified human AAT or fresh frozen plasma to restore plasma and local tissue levels of AAT appears rational, safe, and effective 1.
Treatment Options
- Dapsone, either alone in less severe cases, or combined with augmentation therapy, may be of additional value in managing panniculitis 1.
- Family screening and antismoking counseling are essential in managing panniculitis, particularly in cases related to alpha-1 antitrypsin deficiency 1.
- Restoration of plasma AAT levels after liver transplantation led to permanent cure in one case, highlighting the importance of addressing the underlying cause of panniculitis 1.
Management
- Cold compresses, elevation of affected limbs, and rest can help manage symptoms of panniculitis.
- Prompt diagnosis is important as panniculitis can sometimes indicate serious underlying systemic diseases.
From the Research
Diagnosis of Panniculitis
- Panniculitis refers to disorders with inflammation of the subcutaneous fat, which can be primary or a reaction pattern induced by a systemic process 2
- The diagnosis of panniculitis can be challenging, and a clinical approach is necessary to obtain useful information for a specific diagnosis 3
- Clinical clues, such as tender, erythematous subcutaneous nodules, can aid in the diagnosis, but pathology is often necessary to confirm the diagnosis 2
- The different types of panniculitis are associated with a wide range of etiologies and systemic manifestations, and diagnosis depends on eliminating the underlying cause 4
Treatment of Panniculitis
- Treatment of panniculitis depends on the underlying cause and may include anti-inflammatory and immunosuppressive agents 4
- Supportive care and management of any underlying disorders are often necessary, but certain types of panniculitis, such as infectious panniculitis and malignancy-related panniculitis, require more specific therapies 2
- In some cases, treatment with corticosteroids alone or in combination with other immunosuppressive agents may be effective, but there is no uniform effective therapy available 5
- Mycophenolate mofetil has been shown to be effective in treating relapsing idiopathic nodular panniculitis (Pfeifer-Weber-Christian disease) in some cases 5
- Stopping treatment with methotrexate can lead to the disappearance of subcutaneous nodules in patients with panniculitis, as seen in a case of a patient undergoing treatment for dermatomyositis 6