CLINACASE

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ID: 114
Category: Skin Condition
CreatedBy: 1
UpdatedBy: 1
createdon: 25 Jan 2023
updatedon: 21 Jun 2023

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Author: Khoa Tran
Published Jan 25, 2023
Updated Jun 21, 2023

Table of contents

Panniculitis

Etymology and Pronunciation

Panniculitis (pan-ik-yoo-LY-tis)
panniculus - Greek for "a small rag" or "a small piece of cloth". Referencing the dense layer of fat located beneath the dermis.
-olus - Latin for "small"
-itis - Greek for "inflammation"

History of Panniculitis

The term "panniculitis" was first used in medical literature in the early 20th century to describe a group of disorders characterized by inflammation of the subcutaneous fat tissue. French physician Louis Brun described a case of what he called "nodular subcutaneous fat necrosis" in 1922, and over the next several decades, researchers continued to describe similar cases and began to identify specific underlying causes of panniculitis.

In the 1950s and 60s, researchers began to investigate the histopathology of panniculitis in more detail, identifying specific cellular and tissue changes that occur in affected individuals. They also developed new diagnostic techniques, such as skin biopsy and imaging studies, which have since become standard for the diagnosis of panniculitis.

Modern Understanding of Panniculitis

Panniculitis is a condition that results in the inflammation of subcutaneous fat, the layer of fat beneath the skin. The common symptoms of panniculitis include the formation of nodules, redness, tenderness, swelling, heat, and pain in the affected area. It can affect people of any age and can occur in different parts of the body.

There are different types of panniculitis, each with its own set of symptoms and causes:
  1. Erythema nodosum:
    • This is the most common form of panniculitis.
    • It looks like bruises front of your lower legs.
    • It also causes more general symptoms like fever, headache, and eye problems.
  2. Cold panniculitis
    • This type affects areas of skin that have been exposed to extreme cold, such as can occur when spending time outdoors.
  3. Lipodermatosclerosis
    • This type is linked to vein problems and obesity.
    • It often affects overweight women over 40.
  4. Erythema induratum
    • This form affects the calves of middle-aged women.
  5. Subcutaneous sarcoidosis
    • This type is caused by the disease sarcoidosis.
  6. Weber-Christian disease
    • This term is used to describe a form of the disease that often affects women in midlife.
    • It causes bumps on the thighs and lower legs.
    • It can also involve other organs.
Panniculitis is caused by a variety of factors, including infection, injury, or an underlying medical condition such as lupus. In some cases, the cause of panniculitis is unknown. A biopsy of the affected skin, along with blood tests such as a rheumatoid factor test, antinuclear antibody (ANA) test, serum lipid profile, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), can be used to diagnose panniculitis.

Causes of Panniculitis

- Infections: Certain bacterial, viral, and fungal infections can cause panniculitis. This can include infections such as tuberculosis, Yersinia enterocolitica, and herpes zoster.
- Medications: Some medications, such as oral contraceptives, penicillin, and sulfonamides, can cause panniculitis as a side effect.
- Autoimmune disorders: Conditions such as lupus, rheumatoid arthritis, and scleroderma can cause panniculitis.
- Pancreatic disease: Panniculitis can sometimes occur as a complication of pancreatic disease, such as pancreatitis or pancreatic cancer.
- Trauma: Panniculitis can also be caused by physical trauma to the skin, such as a deep bruise or injection.
- Cold temperatures: Cold panniculitis is a type of panniculitis that occurs when the skin and subcutaneous tissue are exposed to extreme cold temperatures.
- Idiopathic: In some cases, the cause of panniculitis is unknown (idiopathic).

Treatments for Panniculitis

Treatment for panniculitis depends on the underlying cause, but may include antibiotics to treat an infection, steroids to reduce inflammation, tumor necrosis factor (TNF) inhibitors, or rituximab. In severe cases, radiation therapy or surgical excision may be recommended.

Additionally, supportive care, such as wound care and pain management, is important to help alleviate symptoms and improve recovery. People with panniculitis are advised to seek medical attention to get an accurate diagnosis and appropriate treatment.

Symptoms

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Bumps that grow quickly in size, spreading into painful clusters up to an inch (2.5 centimeters) in diameter
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Red spots on skin
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Painful small inflamed bumps on your arms, face, neck or back
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Red spots on skin

Confirmation Tests

- Skin biopsy

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