Panniculitis: Recognition and diagnosis
- Lela Lee, MD
Lela Lee, MD
- Clinical Professor of Dermatology
- University of Colorado School of Medicine
Panniculitis (inflammation of the subcutaneous fat) is a relatively uncommon condition that usually presents with inflammatory nodules or plaques. A wide variety of subtypes of panniculitis exist, including panniculitides related to infection, external insults, malignancy, and inflammatory diseases (table 1).
The diagnosis of panniculitis can be challenging because different forms of panniculitis may present with similar clinical findings and many types of panniculitis are rare. A careful clinical assessment that includes an evaluation of patient risk factors, lesion distribution, and associated clinical findings (eg, ulceration, sclerosis, atrophy) can provide valuable clues for diagnosis.
Although histopathologic examination of the affected area can be of benefit, interpretation of the biopsy findings must be approached with discretion. In the absence of careful clinical correlation and thorough consideration of the clinical and pathologic differential diagnoses, an incorrect diagnosis may be selected.
The approach to the recognition and diagnosis of panniculitis will be discussed here. The clinical features and management of specific forms of panniculitis are reviewed in greater detail separately.
The term panniculitis refers to a group of inflammatory disorders in which the primary site of inflammation is in the subcutaneous fat. In contrast, inflammatory disorders that mainly involve the overlying dermis or underlying fascia and incidentally extend into the nearby subcutaneous fat are not considered types of panniculitis.
- Patterson JW. Panniculitis. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP (Eds), Elsevier Ltd, London 2008. p.1515.
- Mert A, Kumbasar H, Ozaras R, et al. Erythema nodosum: an evaluation of 100 cases. Clin Exp Rheumatol 2007; 25:563.
- Requena L, Yus ES. Erythema nodosum. Dermatol Clin 2008; 26:425.
- Kirsner RS, Pardes JB, Eaglstein WH, Falanga V. The clinical spectrum of lipodermatosclerosis. J Am Acad Dermatol 1993; 28:623.
- Requena C, Sanmartín O, Requena L. Sclerosing panniculitis. Dermatol Clin 2008; 26:501.
- Requena L, Sánchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol 2001; 45:325.
- Martens PB, Moder KG, Ahmed I. Lupus panniculitis: clinical perspectives from a case series. J Rheumatol 1999; 26:68.
- Peters MS, Su WP. Lupus erythematosus panniculitis. Med Clin North Am 1989; 73:1113.
- Morgan AJ, Schwartz RA. Cutaneous polyarteritis nodosa: a comprehensive review. Int J Dermatol 2010; 49:750.
- Requena L, Yus ES. Panniculitis. Part I. Mostly septal panniculitis. J Am Acad Dermatol 2001; 45:163.
- Mascaró JM Jr, Baselga E. Erythema induratum of bazin. Dermatol Clin 2008; 26:439.
- Delgado-Jimenez Y, Fraga J, García-Díez A. Infective panniculitis. Dermatol Clin 2008; 26:471.
- Moreno A, Marcoval J, Peyri J. Traumatic panniculitis. Dermatol Clin 2008; 26:481.
- Quesada-Cortés A, Campos-Muñoz L, Díaz-Díaz RM, Casado-Jiménez M. Cold panniculitis. Dermatol Clin 2008; 26:485.
- Sanmartín O, Requena C, Requena L. Factitial panniculitis. Dermatol Clin 2008; 26:519.
- Ochoa CD, Valderrama V, Mejia J, et al. Panniculitis: another clinical expression of gout. Rheumatol Int 2011; 31:831.
- Snider AA, Barsky S. Gouty panniculitis: a case report and review of the literature. Cutis 2005; 76:54.
- García-Romero D, Vanaclocha F. Pancreatic panniculitis. Dermatol Clin 2008; 26:465.
- Valverde R, Rosales B, Ortiz-de Frutos FJ, et al. Alpha-1-antitrypsin deficiency panniculitis. Dermatol Clin 2008; 26:447.
- Gallardo F, Pujol RM. Subcutaneous panniculitic-like T-cell lymphoma and other primary cutaneous lymphomas with prominent subcutaneous tissue involvement. Dermatol Clin 2008; 26:529.
- Torrelo A, Hernández A. Panniculitis in children. Dermatol Clin 2008; 26:491.
- Burden AD, Krafchik BR. Subcutaneous fat necrosis of the newborn: a review of 11 cases. Pediatr Dermatol 1999; 16:384.
- Diaz Cascajo C, Borghi S, Weyers W. Panniculitis: definition of terms and diagnostic strategy. Am J Dermatopathol 2000; 22:530.
- SUGGESTIVE FEATURES
- Inflammatory disorders
- Enzymatic destruction
- Infants and children
- PATIENT EVALUATION
- Patient history
- Physical examination
- - Procedure
- - Interpretation
- - Special studies
- Additional tests
- SUMMARY AND RECOMMENDATIONS