panniculitis

What is Panniculitis?

Panniculitis refers to a group of conditions that involve inflammation of the subcutaneous fat, which is the layer of fat beneath the skin [1]. This condition can result from multiple causes and can manifest in different ways.

Clinical Presentation

The symptoms of panniculitis typically include tender, red or purple bumps (nodules) that originate deep in the subcutaneous layer [4]. These nodules can be painful and may appear as erythematous subcutaneous nodules [5].

Characteristics

Panniculitis is characterized by inflammation of the adipose tissue, which is the most well-known form of this condition [6]. It can also involve fibrosis (scarring) in the mesentery tissues, leading to symptoms in the abdomen [8].

Types of Panniculitis

There are several types of panniculitis, including erythema nodosum, which is a well-known form of this condition [6]. Other forms include mesenteric panniculitis and subcutaneous fat necrosis.

Causes

The causes of panniculitis can be diverse and may include infections, autoimmune disorders, and other conditions. The exact cause of panniculitis is often difficult to determine and may require a biopsy for diagnosis [1].

Diagnosis

Diagnosis of panniculitis typically involves clinical evaluation and biopsy [1]. A biopsy can help confirm the presence of inflammation in the subcutaneous fat.

References:

[1] Panniculitis is inflammation of the subcutaneous fat that can result from multiple causes. Diagnosis is by clinical evaluation and biopsy. [4] Panniculitis is characterized by tender, red or purple bumps (nodules) that originate deep in the layer of fat beneath the skin (the subcutaneous layer). [5] most commonly appear clinically as erythematous subcutaneous nodules, but ... [6] Aug 9, 2021 — Panniculitis refers to a group of conditions with inflammation of the adipose tissue, the most well known of which is erythema nodusum. [8] Mesenteric panniculitis is an inflammatory condition that causes fibrosis (scarring) in your mesentery tissues. You may have symptoms in your abdomen.

Panniculitis Signs and Symptoms

Panniculitis, an inflammation of the fat beneath the outer layer of skin, presents with distinct signs and symptoms. The following are commonly reported:

• Tender and erythematous to violaceous subcutaneous nodules: These are tender and red or purple bumps under the skin, often located over the extremities (1).
• Large bumps that are tender to touch: Panniculitis can cause large, painful bumps on the legs, feet, or arms (3).
• Bumps on the legs, feet, or arms: The condition often manifests as bumps on these areas of the body (3).
• Redness and tenderness: The affected area is typically red and tender to the touch (5).
• Fever, headache, and eye symptoms: In some cases, panniculitis can cause more general symptoms like fever, headache, and eye problems (4).

Additionally, in severe cases or when associated with systemic features, panniculitis may present with:

• Fever, malaise, and arthralgia: These are common symptoms in patients with panniculitis, especially when the condition is severe (9).
• Abdominal bloating and swelling: In rare cases, mesenteric panniculitis can cause abdominal symptoms like bloating and swelling (7).

It's essential to note that a diagnosis of panniculitis is typically based on a combination of these symptoms and a physical examination. A biopsy may also be performed to confirm the condition.

References: (1) - [1] (3) - [3] (4) - [4] (5) - [5] (7) - [7] (9) - [9]

Panniculitis, an inflammation of the subcutaneous fat, can be challenging to diagnose due to its varied presentations and potential for multiple causes. Diagnostic tests play a crucial role in confirming the condition.

Clinical Evaluation and Biopsy

• A clinical evaluation by a healthcare professional is essential to assess the symptoms and physical examination findings (2).
• A biopsy of the affected tissue is often necessary to confirm the diagnosis, as it allows for histopathological examination (6).

Additional Tests and Studies

• Additional tests and studies may be required in some cases, including:
  • Microbiological cultures to rule out infections (3)
  • Lab tests to evaluate inflammatory markers or other relevant parameters (4)
  • Polarized light microscopy to examine the tissue structure (3)

Tissue Biopsy

• A tissue biopsy is considered the definitive way of diagnosing mesenteric panniculitis, as it involves surgically removing a piece of the affected tissue for examination (5).

Imaging Studies

• While not always necessary, imaging studies such as MRI or CT scans may be used to support the diagnosis and assess the extent of the condition (11, 12).

Blood Tests

• Blood tests measuring serum levels of α1-antitrypsin are mandatory if suspected mesenteric panniculitis is diagnosed (8).
• However, it's essential to note that blood tests alone cannot confirm the diagnosis.

It's worth noting that a multidisciplinary team approach may be desirable in managing patients with panniculitis, as mentioned in [8].

Treatment Options for Panniculitis

Panniculitis, a rare inflammatory condition affecting the subcutaneous fat layer, can be challenging to treat. While there is no specific treatment for panniculitis itself, various approaches can help manage symptoms and underlying conditions.

• Corticosteroids: These anti-inflammatory medications are often the first line of treatment for mesentery panniculitis, and they may provide relief in some cases [5].
• Immunosuppressive agents: Corticosteroids and other immunosuppressive or chemotherapeutic agents have been used to treat patients with progressive or severe forms of panniculitis [7].
• Supportive care: Treatment for panniculitis is focused on supportive care, including managing any underlying illnesses contributing to the symptoms [4].
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as aspirin, ibuprofen, or diclofenac can be used to reduce pain and inflammation [3].

It's essential to note that panniculitis treatment is often tailored to the individual patient's needs and may involve a combination of these approaches. In some cases, no specific treatment for panniculitis itself is available, but managing symptoms and underlying conditions can help alleviate discomfort.

References:

[1] Braunstein I (2012) - The primary treatments used for the panniculitis of dermatomyositis are systemic corticosteroids and immunosuppressives. [3] Compression hosiery (18–25 mm Hg pressure if these can be tolerated); Pain relief using anti-inflammatory medications such as aspirin, ibuprofen or diclofenac [4] Treatment of panniculitis is focused on supportive care, treating any underlying illnesses contributing to the symptoms, nonsteroidal anti-inflammatory drugs (NSAIDs) [5] Corticosteroids, drugs that reduce inflammation, are the first line of treatment for mesentery panniculitis, and they often do the trick. [7] Corticosteroids (1 to 2 mg/kg orally or IV once a day) and other immunosuppressive or chemotherapeutic agents have been used to treat patients with progressive forms of panniculitis.

Understanding Differential Diagnosis in Panniculitis

Panniculitis, a condition characterized by inflammation of the subcutaneous fat, can be challenging to diagnose due to its varied presentations and potential for misdiagnosis. The differential diagnosis of panniculitis involves identifying other conditions that may mimic its symptoms.

Key Conditions to Consider:

• Infectious processes: Bacterial and fungal infections are among the differential diagnoses for panniculitis, particularly when abscesses are present.
• Erythema nodosum: This condition typically lacks abscesses and is often mistaken for cellulitis due to its similar presentation of tender dermal or subcutaneous nodules, papules, or plaques.
• Post-steroid panniculitis and frostbite: These conditions share a common presentation with panniculitis and may be considered in the differential diagnosis.

Importance of Accurate Diagnosis

Accurate diagnosis is crucial to ensure proper treatment and management of panniculitis. A combination of clinical features, biopsy findings, and microbiological culture can help differentiate panniculitis from other conditions.

Sources:

• [3] Panniculitis is a broad term for conditions resulting from inflammation of the subcutaneous fat, which can be due to infection, trauma, ...
• [5] Panniculitis is an inflammation of the subcutaneous fat. Skin biopsy plays a critical role in the differential diagnosis of panniculitis.
• [7] Conditions in the differential diagnosis include the following: Differential diagnosis also includes post-steroid panniculitis and frostbite.

References:

[3], [5], [7]

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