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Panniculitis

Panniculitis is the appellation acclimated to describe diseases where the major focus of inflammation is in the subcutaneous tissue. In general, panniculitis presents as erythematous or violaceous nodule in the subcutaneous fat that may be tender or not, that may ulceamount or alleviate without scarring, and that may be bendable or adamantine on palpation. appropriately, the appellation panniculitis describes a advanced spectrum of disaffluence manifestations, although diagnostic clues can be derived from the history, distribution, or characteristics of the lesions. An accuamount diagnosis requires an ample abysmal bark biopsy that should ranniversary bottomward to or alike beyond the fascia.

The panniculitides are classified histologically as lobular or septal depending on where the disaffluence process begins. Panniculitis may additionally be associated with vasculitis or in best cases without vasculitis.

alone idiopathic lobular panniculitis (Pfeiffer­Weber-Christian disease), pancreatic panniculitis, and al antitrypsin-deficiency panniculitis are briefly discussed here. Other diseases in which panniculitis occurs are referred to in the table, and the reader is additionally referred to Fitzpatrick's Dermatology in General Medicine, 5th ed.1

Idiopathic lobular panniculitis, which occurs predominantly in females 30 to 60 yaerial of age, manifests as subcutaneous inflammatory nodules, primarily on the lower extremities but additionally on the trunk and abroadwhere, that erupt in crops and are usually tender. New beachcombers of lesions appear at intervals. Occasionally, lesions can break bottomward, discharging an adipose yellow-brown liquid; and these inflammatory nodules are generally accompanied by malaise, fatigue, fever, arthralgia, and myalgia. Due to systemic involvement there may be focal necrosis in the intravisceral and perivisceral fat of internal organs, including the mesenteric and omental fat, pericardium, and pleura. Organ involvement may present as hepatomegaly, abdominal pain, nausea, and vomiting.

Leukocytosis and an elevated erythrocyte sedimentation amount are further characteristics of this disease, of which the etiology is unknown. The course and prognosis are variable; the prognosis is acceptable in patients who accept alone cutaneous involvement, but lobular panniculitis associated with brawlinent visceral involvement may advance to death. There is no unianatomy effective therapy recognized; fibrinolytic agents, chloroquine, azathioprine, thalidomide, cyclophospharnide, and cyclosporine accept been tried.

α 1 antitrypsin-deficiency panniculitis is additionally characterized by recurrent tender, erythematous, subcutaneous, ulcerating nodules ranging from 1 to 5 cm and located predominantly the trunk and the proximal extremities. Nodules break bottomward and discharge a clear serous or adipose fluid. Diagnosis is substantiated by a de, in the level of serum α 1 antitrypsin, and treatment consists of articulate dapsone in dosages up to 200 mg/d. The intravenous infusion of human α 1 proteinase inhibitor concentamount has been sit to be actual effective.

Pancreatic panniculitis is characterized clinically by painful erythematous nodules that occur at any armpit. It is frequently accompanied by arthritis and polyserositis and is associated with either pancreatitis or pancreatic carcinoma. This anatomy of panniculitis affects middle-age to elderly individuals, machos added often than females. The history usually reveals alcoholism abdominal pain, weight loss, or recent-onset diabetes mellitus. bark lesions are tender, balmy, erythematous nodules and plaques that fluctuate and occur at any armpit with a predilection for legs, buttocks, and abdomen. bark biopsy reveals lobular panniculitis, and In the column biopsy of a lesion, liquefied fat drains from the biopsy armpit. General examination may reveal pleural effusion, ascites and arthritis, allotmenticularly of the ankles.

Laboratory examinations appearance eosinophilia, hyperlipasemia, hyperamylasemia, and increased excretion of amylase and/or lipase in the urine. The pathophysiology is probably a break bottomward of subcutaneous fat caacclimated by enzymes (amylase, trypsin, lipase) released into the circulation from a diseased pancreas. The course and prognosis depend on the blazon of pancreatic disease.

Treatment is often unsatisfactory. Some physicians may use anti-inflammatory medications. Some patients with certain blazons of panniculitis may respond to adjustined chemotherapy with cyclophosphamide, bleomycin and prednisone.