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Panniculitis

A nodular panniculitis is a descriptive term for panniculitis secondary to many causes.
Lesions are typically ill-defined, subcutaneous masses up to many centimeters across. Following destruction of the subcutaneous fat, depressions are common. Ulceration can also occur.

Causes of nodular panniculitis
  • alpha1-antitrypsin inhibitor deficiency. Severe panniculitis can result from the deficiency of this protease inhibitor. Extensive areas of cellulitis-like involvement are seen, with ulceration common.
  • Vasculitis of the larger, deeper vessels can result in a nodular panniculitis. Such a vasculitic process may include lesions of erythema nodosum, erythema induratum, and lupus panniculitis.
  • Cold panniculitis. Cold injury to fat tissue can result in a panniculitis.
  • Post-steroid panniculitis can occur secondary to the abrupt withdrawal of high dose systemic steroids.
  • Idiopathic nodular panniculitis, also known as Weber-Christian disease, is of unknown etiology. Lesions most typical on the lower extremities, but can occur on the trunk. There can be an associated fever, malaise, arthralgia, and myalgia.
  • Panniculitis secondary to pancreatic enzyme release. Chronic or acute pancreatitis can release lipolytic enzymes, which can cause fat necrosis.

Treatment:

  • Alfa 1 anti-trypsin deficiency
  • A1AT concentrate
  • Case report on the benefit of Dapsone and Colchicine
  • Liver transplant could be considered in severe cases
  • Nodular vasculitis may be treated with non-steroidal anti-inflammatories, potassium iodide, anti-malarials, Colchicine.
  • Treat underlying tuberculosis
panniculitis


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