From the Guidelines
Panniculitis is a condition characterized by inflammation of the subcutaneous fatty tissue, leading to painful nodules or hardened skin, typically on the legs or buttocks, and can be associated with various underlying causes, including alpha-1 antitrypsin deficiency, as described in the American Thoracic Society/European Respiratory Society statement 1.
Definition and Characteristics
Panniculitis can result from infections, autoimmune disorders, physical trauma, cold exposure, or as a side effect of certain medications. The condition causes painful lumps or areas of hardened skin, and there are several types of panniculitis, each with distinct characteristics, such as erythema nodosum, lupus panniculitis, and pancreatic panniculitis.
Diagnosis and Treatment
Treatment depends on the underlying cause and may include anti-inflammatory medications like NSAIDs or corticosteroids, antibiotics if infection is present, or management of the underlying condition, as noted in the American Thoracic Society documents 1. In some cases, immunosuppressive drugs might be necessary for autoimmune-related panniculitis.
Key Considerations
- Panniculitis can be acute or chronic, with some forms resolving on their own while others require ongoing treatment.
- If you develop unexplained painful nodules under your skin, especially if accompanied by other symptoms like fever or joint pain, medical evaluation is important for proper diagnosis and treatment.
- Augmentation therapy with purified human AAT or fresh frozen plasma to restore plasma and local tissue levels of AAT appears rational, safe, and effective, particularly in cases of alpha-1 antitrypsin deficiency–associated panniculitis 1.
- Dapsone, either alone in less severe cases, or combined with augmentation therapy, may be of additional value, although its mechanism of action in this setting is unclear 1.
From the Research
Definition of Panniculitis
- Panniculitis is an inflammation of the subcutaneous fat, a relatively uncommon condition that usually presents with inflammatory nodules or plaques 2, 3, 4.
- It can be divided into septal and lobular types based on the histopathologic features 3, 4.
Types of Panniculitis
- Septal panniculitis: includes erythema nodosum, which is the most frequent form of panniculitis 2, 3.
- Lobular panniculitis: includes lupus panniculitis, subcutaneous panniculitis-like T-cell lymphoma, and sarcoidosis 3.
- Other types: include neutrophilic panniculitis, cytophagic histiocytic panniculitis, and subcutaneous fat necrosis 3, 5, 6.
Clinical Presentation
- Panniculitis can present with painful erythematous nodules or plaques, fever, malaise, and symptoms of an upper respiratory tract infection 2, 6.
- The lesions can be localized on the extensor aspect of the limbs, and can progress to subcutaneous atrophy and lipoatrophy 2, 6.
Diagnosis and Treatment
- Diagnosis is based on the integration of clinical and histological data, and skin biopsy plays a critical role in the differential diagnosis of panniculitis 3.
- Treatment depends on the underlying cause, and can include anti-inflammatory and immunosuppressive agents, such as corticosteroids, mycophenolate mofetil, and hydroxychloroquine 2, 5, 4, 6.