Panniculitis

Aka: Panniculitis

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II. Definition

  1. Subcutaneous fat inflammation

III. Causes: Mostly Septal

  1. Vasculitis
    1. Leukocytoclastic Vasculitis (Vasculitis of small veins)
    2. Superficial Thrombophlebitis (thrombosis of large veins)
    3. Cutaneous Polyarteritis Nodosa (arteries and arterioles)
  2. No Vasculitis
    1. Erythema Nodosum
    2. Granuloma Annulare
    3. Necrobiosis Lipoidica
    4. Necrobiotic xanthogranuloma
    5. Rheumatoid Nodule
    6. Scleroderma

IV. Causes: Mostly Lobular

  1. Vasculitis
    1. Nodular Vasculitis
      1. Associated with Tuberculosis
      2. Found on lower legs
    2. Erythema Induratum (Bazin disease)
      1. Panniculitis on the back of the calves
    3. Crohns Disease
    4. Leprosy
    5. Lucio's phenomenon
    6. Rheumatoid Arthritis (Neutrophilic lobular Panniculitis)
  2. No Vasculitis
    1. Connective Tissue Disorders
      1. Systemic Lupus Erythematosus
      2. Dermatomyositis
      3. Alpha-1 Antitrypsin Deficiency
      4. Pancreatic Panniculitis (Pancreatic Cancer, Pancreatitis)
      5. Sarcoidosis
    2. Crystal deposition in fat
      1. Gout
      2. Sclerema neonatorum
      3. Subcutaneous Fat Necrosis of the newborn
      4. Post-Corticosteroid Panniculitis
    3. Tissue Injury
      1. Cellulitis or other soft tissue infection
      2. Chemicals (Iodides, bromides)
      3. Cold Panniculitis
      4. Factitious Panniculitis (injected organic materials such as Saliva, urine beneath skin)
      5. Lipoatrophy
      6. Post-radiation Panniculitis
      7. Traumatic Panniculitis
    4. Miscellaneous conditions
      1. Subcutaneous T-Cell Lymphoma
      2. Sclerosing Panniculitis (Chronic Venous Insufficiency)
      3. Vascular calcifications (Oxalosis, Calciphylaxis)

V. Signs

  1. Thick, indurated, red or brown nodular lesions
  2. Variably tender
  3. Lipodystrophy (fat atrophy) may follow resolution

VI. References

  1. Stanway (2015) Panniculitis, DermNet, accessed 12/15/2015
    1. http://www.dermnetnz.org/dermal-infiltrative/panniculitis.html
  2. Requena (2001) J Am Acad Dermatol 45(2):163-83 +PMID:11464178 [PubMed]
  3. Requena (2001) J Am Acad Dermatol 45(3):325-61 +PMID:11511831 [PubMed]

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