EF00
5.3.1 Panniculitis
Grading & Level of Importance: B
ICD-11
Synonyms
None.
Epidemiology
Rare depending on underlying cause.
Definition
A heterogeneous group of diseases showing inflammation of subcutaneous adipose tissue.
Aetiology & Pathogenesis
Various underlying causes of suppurative and non-suppurative panniculitis:
- As part of morphea or scleroderma
- Due to alpha1-antitrypsin deficiency
- Post trauma
- Post infection
- Subcutaneous panniculitis T-cell lymphoma
- Lupus profundus
In association with:
- Tuberculosis (erythema induratum)
- Pancreatic disease
- Perinatal asphyxia or hypothermia (sclerema neonatorum and subcutaneous fat necrosis of the newborn)
- Post-steroid therapy
- Autoimmune dermatoses (systemic lupus erythematosus; dermatomyositis)
- Post trauma including surgery
- Post infection
- Chronic venous insufficiency (lipodermatosclerosis).
There may be overlapping causes of panniculitis (e.g. lupus erythematosus and trauma).
Signs & Symptoms
Can be asymptomatic or affected areas tender on pressure. Fever, joint pains, systemic upset and ulcers may be present. Signs on examination of other systems may be helpful to make a clinical diagnosis.
Localisation
Varies according to underlying cause. Lupus panniculitis: upper torso and hips. Alpha1-antitrypsin deficiency-associated panniculitis: pelvic girdle. Erythema induratum and lipodermatosclerosis: lower legs.
Classification
Predominantly septal panniculitis:
- As part of morphea or scleroderma
- Due to alpha1-antitrypsin deficiency
- Erythema nodosum
Lobular and mixed septal/lobular panniculitis: all other types listed above.
Laboratory & other workups
Depending on the underlying diagnosis.
Dermatopathology
Usually not necessary. Isolated pure forms of panniculitis are rare, and clinical and other laboratory features should be considered.
Course
Depending on the underlying cause. Some forms will burn out leaving hard permanent scars. Longstanding and migrating subtypes exist.
Complications
Depending on the underlying cause.
Diagnosis
Clinical features. Occasionally biopsy may be required.
Differential diagnosis
Polyarteritis nodosa, nodular vasculitis and, cellulitis, cutaneous T-cell lymphoma.
Prevention & Therapy
Depending on aetiology.
Special
None.
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