Panniculitis (overview) M79.3

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 19.10.2021

Dieser Artikel auf Deutsch


Fatty tissue inflammation; Panniculitis

This section has been translated automatically.

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".

Based on 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.

This section has been translated automatically.

Lobular panniculitis*:

Septal panniculitis*:

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

This section has been translated automatically.

Depending on the underlying disease.

This section has been translated automatically.

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
This section has been translated automatically.

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.

This section has been translated automatically.

See under 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 longer-standing panniculitis, resorptive inflammatory reparative processes override the initiating process. These reparative processes are largely identical histomorphologically for all forms of panniculitis and are therefore diagnostically inconclusive. The biopsy must be performed as a wide excision biopsy as "atraumatically" as possible and extend to the muscle fascia. Punch biopsies are not indicated because of the lack of depth of the excision.

This section has been translated automatically.

Deep skin biopsy, sonography (7.5 MHz).

This section has been translated automatically.

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.

This section has been translated automatically.

  1. Chen HC et al (2004) Neutrophilic panniculitis with myelodysplastic syndromes presenting as pustulosis: case report and review of the literature. Am J Hematol 76:61-65.
  2. Ferrara G et al (2013) Panniculitis with vasculitis. G Ital Dermatol Venereol 148:387-394
  3. Grassi S et al (2013) Panniculitis in children. G Ital Dermatol Venereol 148:371-385
  4. Kolb-Mäurer A (2015) Panniculitis in pancreatitis.JDDG 13: 807-809.
  5. Passarini B et al (2013) Erythema nodosum. G Ital Dermatol Venereol148:413-417 Review. PubMed PMID: 23900162.
  6. Patterson JW (2003) Panniculitis. In: Bologna JL et al (eds) Dermatology, Mosby London New York Toronto, pp 1551-1552.
  7. Perasole A (2013) Infectious panniculitides: an update. G Ital Dermatol Venereol 148:427-433
  8. Rongioletti F et al (2013) Pancreatic panniculitis. G Ital Dermatol Venereol 148:419-425
  9. Xiao W et al (2021) Panniculitis caused by progesterone injection can be treated by physical therapy. Dermatol Ther 34:e14501.


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


Last updated on: 19.10.2021