Panniculitis (overview) M79.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 12.05.2021

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Synonym(s)

Fatty tissue inflammation; Panniculitis

Definition
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Polyaetiological, heterogeneous group of mostly localised, rarely generalised, inflammatory diseases of the adipose tissue (panniculus = lobules) in which a phasic, reactive inflammatory process takes place, which ends either in a restitutio ad integrum or in scarring defect healing (adipose tissue atrophy), recognisable by retracted defects of the skin surface.

There is no generally accepted classification of panniculitis, so all classificatory approaches have always been provisional.

For example, different names are used by clinicians and pathologists for the same clinical picture (erythema induratum vs nodular vasculitis).

Also, older terminology has become obsolete, such as " panniculitis nodularis nonsuppurativa febrilis et recidivans".

On the basis of new findings, it can be assumed that the term panniculitis nodularis nonsuppurativa febrilis et recidivans conceals several distinct clinical pictures, such as AAT deficiency-associated panniculitis, pancreatic panniculitis or lupus panniculitis. The present classification is based primarily on histological criteria (septal vs. lobular; with vasculitis vs. without vasculitis), and secondarily on etiological (traumatic, infectious, articular) criteria. However, it must be clarified that the subdivision into septal and lobular panniculitis is often difficult, since pure forms are rather rare and mixed pictures are the rule.

Classification
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Lobular panniculitis*:

Septal panniculitis*:

* Exclusively lobular or septal panniculitis are not observed. Thus, both terms should be understood as "predominantly septal" or "predominantly lobular".

Etiopathogenesis
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Depending on the underlying disease.

Localization
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The lower extremities, buttocks and hips are affected, more rarely the abdomen. Only lupus panniculitis also affects the upper parts of the trunk, arms and face.

Clinical features
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Red to red-blue, firm, usually painful, subcutaneously located, 1.0-10.0 cm large, inflammatory nodules. The overlapping skin is often reddened and sunken, more rarely a putrid ulcer develops.

Histology
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See the individual clinical pictures. The biopsy of an older panniculitis is worthless. To obtain representative material, a deep biopsy of a fresh lesion (first clinical manifestations) is required. In case of prolonged panniculitis, resorptive, inflammatory repair processes overlay the initiating process. These repair processes are histomorphologically largely identical for all forms of panniculitis and are therefore not etiopathogenetically meaningful. The biopsy must be performed as a broad excision biopsy as "atraumatically" as possible and must extend to the muscle fascia. Punch biopsies are not indicated due to the lack of depth of the excision.

Diagnosis
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Deep skin biopsy, sonography (7.5 MHz).

Therapy
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Two basic principles must be observed: symptomatic and pragmatic treatment of the inflammatory process and identification of the cause and treatment of the underlying disease.

Literature
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  1. Ferrara G et al (2013) Panniculitis with vasculitis. G Ital Dermatol Venereol 148:387-394
  2. Grassi S et al (2013) Panniculitis in children. G Ital Dermatol Venereol 148:371-385
  3. Kolb-Mäurer A (2015) Panniculitis in pancreatitis.JDDG 13: 807-809
  4. Passarini B et al (2013) Erythema nodosum. G Ital Dermatol Venereol148:413-417 Review. PubMed PMID: 23900162.
  5. Patterson JW (2003) Panniculitis. In: Bologna JL et al (ed.) Dermatology, Mosby London New York Toronto, pp. 1551-1552
  6. Perasole A (2013) Infectious panniculitides: an update. G Ital Dermatol Venereol 148:427-433
  7. Rongioletti F et al (2013) Pancreatic panniculitis. G Ital Dermatol Venereol 148:419-425

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 12.05.2021