Understanding Panniculitis: Causes and Treatments

Panniculitis is a group of inflammatory conditions that affect the fatty layer of tissue beneath the skin, known as the panniculus. This umbrella term encompasses a variety of subtypes, each with its own set of causes, symptoms, and treatments.

While the condition can affect individuals of all ages, it presents unique challenges when it occurs in children.

What is Panniculitis?

Panniculitis is characterized by inflammation of the subcutaneous fat, leading to nodules or lumps under the skin. These nodules can be painful and may vary in size. The condition can be acute or chronic and can affect different parts of the body. Understanding the types of panniculitis is crucial for accurate diagnosis and treatment.

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Types of Panniculitis

There are several types of panniculitis, each with distinct characteristics:

Erythema Nodosum

Erythema nodosum is the most common type of panniculitis, often linked to infections, medications, or systemic diseases like sarcoidosis. It presents as red, tender nodules, usually on the shins.

Weber-Christian Disease

Also known as idiopathic relapsing febrile nodular panniculitis, this type is characterized by recurring episodes of fever and painful nodules. The exact cause remains unknown.

Lupus Panniculitis

Associated with systemic lupus erythematosus, this type manifests as firm, deep nodules that can lead to scarring.

Subcutaneous Sarcoidosis

This rare form of panniculitis is associated with sarcoidosis, a systemic disease that affects multiple organs, including the lungs and skin.

Mesenteric Panniculitis

Mesenteric panniculitis affects the fat tissue in the mesentery, which is part of the abdominal cavity. This type is often identified through radiological imaging.

Causes of Panniculitis

The causes of panniculitis are varied and can be multifactorial. Common causes include:

Infections: Bacterial, viral, or fungal infections can trigger panniculitis.
Medications: Certain drugs, including antibiotics and oral contraceptives, have been linked to the condition.
Systemic Diseases: Conditions like lupus, sarcoidosis, and inflammatory bowel disease can cause panniculitis.
Trauma: Physical injury to the fatty tissue can lead to inflammation.
Cold Exposure: Prolonged exposure to cold temperatures can result in cold panniculitis, particularly in infants.

Symptoms of Panniculitis

The symptoms of panniculitis can vary depending on the type and severity of the condition. Common symptoms include:

Nodules: Firm, tender lumps under the skin, often red or purple in color.
Pain: The nodules can be painful, especially when pressure is applied.
Fever: Some types of panniculitis are associated with fever and systemic symptoms.
Fatigue: Chronic panniculitis can lead to generalized fatigue and malaise.
Skin Changes: The affected skin may become discolored or ulcerated over time.

Diagnosis of Panniculitis

Diagnosing panniculitis requires a comprehensive approach, often involving multiple diagnostic methods:

Clinical Examination

A thorough clinical examination is the first step in diagnosing panniculitis. The physician will assess the nodules' size, location, and tenderness.

Biopsy

A skin biopsy is essential for confirming the diagnosis. The biopsy sample is examined under a microscope to identify the specific type of panniculitis and rule out other conditions.

Blood Tests

Blood tests can help identify underlying systemic diseases or infections that may be causing panniculitis. Tests may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), and antinuclear antibodies (ANA).

Radiology

Radiological imaging, such as ultrasound, CT scans, or MRI, can provide detailed images of the affected areas. Mesenteric panniculitis, in particular, is often diagnosed through radiological methods.

Complications of Panniculitis

While panniculitis itself is not life-threatening, it can lead to complications if left untreated:

Scarring: Chronic panniculitis can result in permanent scarring of the affected skin.
Infections: Open sores or ulcerations can become infected, leading to further complications.
Systemic Involvement: In severe cases, panniculitis can affect internal organs, leading to systemic symptoms and complications.

Treatment Options for Panniculitis

The treatment of panniculitis depends on the underlying cause and the type of panniculitis. Common treatment options include:

Medications

Anti-inflammatory Drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.
Corticosteroids: These are often prescribed for severe cases to reduce inflammation quickly.
Antibiotics: If an infection is causing panniculitis, antibiotics may be necessary.
Immunosuppressants: For autoimmune-related panniculitis, medications that suppress the immune system may be prescribed.

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Lifestyle Changes

Rest: Adequate rest can help reduce symptoms and promote healing.
Compression Stockings: For panniculitis affecting the legs, compression stockings can help reduce swelling and improve circulation.
Diet: A balanced diet rich in anti-inflammatory foods may help manage symptoms.

Surgical Intervention

In rare cases, surgical intervention may be necessary to remove severely affected areas of fat tissue.

Panniculitis in Children

Panniculitis can also affect children, presenting unique challenges in diagnosis and treatment. Pediatric cases often require a multidisciplinary approach, involving pediatricians, dermatologists, and rheumatologists. Early diagnosis and appropriate treatment are crucial to prevent complications and ensure a good quality of life for affected children.

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