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.

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)

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.

Diagnosis

• Clinical evaluation
• Excisional biopsy

Diagnosis is by usually by clinical appearance and can be confirmed by excisional biopsy.

Treatment

• Supportive care
• Anti-inflammatory drugs
• Immunosuppressants

There is no specific definitive treatment for panniculitis. A variety of 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. Surgical abdominal panniculectomy has been used with varying levels of success in morbidly obese patients but should be reserved for patients with serious disease that does not respond to other measures.

Last full review/revision October 2009 by Wingfield E. Rehmus, MD, MPH