Panniculitis

By Wingfield E. Rehmus, MD, MPH, Clinical Assistant Professor, University of British Columbia

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Hypersensitivity and Inflammatory Disorders
Introduction to Hypersensitivity and Inflammatory Disorders
Acute Febrile Neutrophilic Dermatosis
Drug Eruptions and Reactions
Erythema Multiforme
Panniculitis
Erythema Nodosum
Granuloma Annulare
Pyoderma Gangrenosum
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

Panniculitis describes inflammation of the subcutaneous fat that can result from multiple causes. Diagnosis is by clinical evaluation and biopsy. Treatment depends on the cause.

Panniculitis can be classified as lobular or septal depending on the principal site of the inflammation within the fat.

Etiology

There are multiple causes of panniculitis, including

Infections (the most common)
Physical factors (eg, cold, trauma)
Proliferative disorders
Connective tissue disorders (eg, SLE, systemic sclerosis)
Pancreatic disorders
Alpha₁-antitrypsin deficiency

Idiopathic panniculitis is sometimes referred to as Weber-Christian disease.

Symptoms and Signs

Panniculitis is characterized by tender and erythematous subcutaneous nodules located over the extremities and sometimes over the posterior thorax, abdominal area, breasts, face, or buttocks. Rarely, nodules can involve the mesentery, lungs, scrotum, and cranium. Signs of systemic inflammation can accompany panniculitis. In Weber-Christian disease, systemic involvement can result in fever as well as signs of organ dysfunction, including hepatic, pancreatic, and bone marrow insufficiency, which is potentially fatal.

Treatment

Supportive care
Anti-inflammatory drugs
Immunosuppressants

There is no specific definitive treatment for panniculitis. Several strategies have been used with modest results, including NSAIDs, antimalarials, dapsone, and thalidomide. Corticosteroids (1 to 2 mg/kg po or IV once/day) and other immunosuppressive or chemotherapeutic drugs have been used to treat patients with progressive symptoms or signs of systemic involvement.

Key Points

Causes of panniculitis can vary widely.
Diagnose panniculitis by clinical evaluation (including presence of tender, red, subcutaneous nodules) and confirm with excisional biopsy.
Treat panniculitis supportively and consider anti-inflammatory or immunosuppressive drug therapy, particularly if manifestations are severe.