Last reviewed by mvhs13 on August 13th, 2018.
Panniculitis described a group of condition characterized by the inflammation of subcutaneous adipose tissue or the fatty layer in the deeper layer of the skin. This condition usually occurs in the lower legs and on the thighs. It can also extend to other areas of the body such as in the chest and in the forearms.
Panniculitis can be classified as either mostly lobular or mostly septal. When it is lobular, the inflammation is mostly in the fat lobules. In mostly septal, the inflammation is mostly in the connective tissues. The classifications of Panniculitis however, are based on the histological characteristic of the inflammation in relation to the location. The presence or absence of a vasculitis is also included in the factor of classifying Panniculitis.
The onset of Panniculitis may occur without symptoms or may be associated with systemic symptoms depending on the cause of Panniculitis. The symptoms may be due a systemic disease that occurs along with Panniculitis.
Panniculitis itself is characterized by the formation of subcutaneous nodules which may be solitary or in a multitude. The nodule is described as erythematous and tender and develops on the thighs, forearms and the legs and may also develop in the face, chest, breast, abdominal region and the buttocks. The nodule may appear as raised lump beneath the skin or may appear as large flat thickened skin. The surface of the nodule may feel woody and hard and the color of the affected skin may be red or darker or it may be brownish in color.
In cases where Panniculitis is associated with a systemic disease, the signs and symptoms may include the following:
- Onset of fever
- Unexplainable weight loss
- Nausea and vomiting
- Joint pain may also occur
The onset of Panniculitis is often recognized by the patient due to pain along with non-specific symptoms. The pain in Panniculitis may cause discomfort to the patient and may affect the quality of life.
Panniculitis associated with Weber-Christian disease, organ dysfunction may be present and can be potentially fatal. This can include hepatic and pancreatic dysfunction including bone marrow insufficiency. Weber-Christian disease on the other hand is referred to as an idiopathic lobular panniculitis.
The hallmark of Panniculitis is the development of nodules under the skin surface and which has a wood-like feeling. It is important that the condition be consulted with a doctor to properly diagnose the condition and to identify as well the cause of the inflammation thereby a prompt and proper management.
Panniculitis is also classified according to the histological characteristics of the inflammation including the location. The presence or absence of vasculitis is also included in classifying Panniculitis. It has also been classified as whether the inflammation is mostly septal or mostly lobular.
Mostly lobular Panniculitis involves inflammation of the fat only and may or may not have the presence of vasculitis.
Mostly lobular panniculitis with vasculitis include the following:
- Nodular vasculitis – is characterized by small, red and tender nodules on the shin and calves. This classification of Panniculitis is being linked with the manifestation of tuberculosis.
- Erythema induratum – is Panniculitis that develops at the back of the calves and is not being linked with any identified pathogen.
Mostly lobular panniculitis without vasculitis include the following:
- Cold panniculitis – is prevalent among infants and young children. It is Panniculitis that occur after an exposure to cold or extreme cold.
- Traumatic panniculitis – is Panniculitis that develops after a trauma to the skin occurs.
- Pancreatic panniculitis – is Panniculitis that occurs in relation to pancreatic carcinoma and seldom in abnormality with pancreatic structure.
- Gouty panniculitis – is Panniculitis that results from the accumulation of uric acid crystals in the gout.
- Cytophagic histiocytic panniculitis – is the fatal form of Panniculitis that involves multiple systems although this type is rather rare.
- Subcutaneous sarcoidosis – is Panniculitis caused by a rare disease called sarcoidosis.
Mostly septal panniculitis with vasculitis include the following:
- Superficial thrombophlebitis – is Panniculitis that involves the superficial vein, which may or may not have a formation of blood clots.
- Leukocytoclastic vasculitis – is Panniculitis that involves the inflammation of blood vessels in the skin.
Mostly septal panniculitis without vasculitis include the following:
- Erythema nodosum – is the most common type of Panniculitis that develops in the shin. No exact cause has been identified in this type of Panniculitis.
- Rheumatoid nodule – involves the connective tissue and which damages the joints of the body.
Panniculitis may be caused by a systemic disease or a localized disease. Panniculitis involving a localized disease is basically limited to a specific area and does not extend to other areas of the body. Systemic disease involvement of Panniculitis on the other hand generally involves the whole body.
- Infection is the most common cause of Panniculitis. The infection may be in the form of a viral or bacterial or it may at times be due to tuberculosis.
- Inflammatory diseases also contribute to the onset of Panniculitis. Crohn’s disease and ulcerative colitis are among the inflammatory disease that can trigger Panniculitis.
- Sarcoidosis – is a rare disease characterized by the formation of clumps from the cells of the body which develops in the lungs and the skin.
There are cases of Panniculitis that resulted from the own immune system of the body. Exposure to cold temperature is also a trigger for the onset, including a recent trauma to the skin.
Panniculitis has no specific treatment. The treatment basically depends on the underlying cause of the disease.
Panniculitis caused by an infection is usually given with antibiotics and anti-inflammatory to treat the infection. Tetracycline is one example of drugs that can treat Panniculitis caused by an infection. The symptoms of pain and nodules can be treated with nonsteroidal anti-inflammatory drugs such as Ibuprofen. Immunosuppressant is used for the treatment of Panniculitis that resulted from the own immune system of the body.
Panniculitis resulting from the medications being taken can be addressed by stopping from taking the drugs although it is important that a doctor be seen.
Surgical removal is intended for Panniculitis that remains persistent or has developed an ulcerated lesion. Compression hosiery can also be used while rest and elevation of the affected area are found to be beneficial.