23- Subcutaneous Fat

Question 1

Most common inflammatory panniculitis

Answer 1

Erythema nodosum

Question 2

Most common in young adult women
Bilateral symmetric deep tender nodules and plaques most common in pretibial area and lateral shins

Over few days- lesions flatten with purple/blue green color, lesions resolve without atrophy or scarring

Answer 2

Acute erythema nodosum

Question 3

Acute erythema nodosum is frequently associated with these infections

Answer 3

Streptococcal
TB
GIT- yersinia salmonella shigella

Question 4

EN is also seen with IBD, more often with this one than the other

Answer 4

Crohns

Question 5

Sarcoidosis may also occur with EN and may present with fever, cough, joint pain and hilar adenopathy.

This syndrome is called

Answer 5

Löfgren syndrome

Question 6

EN may also be induced by medication. The most common are

Answer 6

Oral contraceptives

Hormone replacement therapy

Question 7

Chronic EN is distinguished from acute EN by

Answer 7

Unilateral or asymmetric involvement
Tends to occur in older women
Not associated with systemic symptoms except arthralgia
Painless or less tender

Question 8

Management of erythema nodosum

Answer 8

Rest, elevation, identify trigger
Throat culture, ASO titer
Travel and exposure history
NSAID, restriction of physical activity 
SSKI (saturated solution of K iodide)

Question 9

Tender subcutaneous nodule on the calves of middle aged thick legged women

Lesions bilateral, venous insufficiency may be present, less tender

Often ulcerate, drain oily liquid and recur. Resolves with fibrosis

Answer 9

Nodular vasculitis/ erythema induratum

Question 10

Erythema induratum is clinically similar to nodular vasculitis but it differs due to

Answer 10

TB as precipitating factor in erythema induratum

Question 11

Treatment for erythema induratum and nodular vasculitis

Answer 11

EI- TB treatment

NV- SSKI

Question 12

Occurs on the medial lower third of the lower legs of women older than 40 and above average BMI
Often bilateral, painful
Chronic- inverted champagne bottle calves due to fibrosis of fat

Etiology: venous insufficiency
Gradual progression from ankles characteristic

Answer 12

Lipodermatosclerosis

Question 13

Biopsy should be done in patients with lipodermatosclerosis

True or false

Answer 13

False

-wounds heal poorly and may lead to chronic leg ulcers

Question 14

Treatment for lipodermatosclerosis/sclerosing panniculitis

Answer 14

Compression stockings
Elevation
+ Intralesional triamcinolone and ultrasound therapy

Pentoxyphylline 400-800mg TID
Surgical tx of varicosities

Question 15

Subcutaneous fat necrosis may be accompanied by elevation of

Answer 15

Calcium

Hypercalcemia

Question 16

Severest and rarest disorder of physical panniculitides

Affects premature neonates who are seriously ill or have profound hypothermia

Answer 16

Sclerema neonatorum

Question 17

Granulomatous and fibrotic reaction from the injection of silicone or mineral oils

Localized to penis, scrotum, breast, nose and buttocks- hyperpigmented and erythematous indurated, lumpy and thickened

Answer 17

Sclerosing lipogranuloma

Question 18

Subcutaneous fat necrosis is most commonly associated with this disease

Answer 18

Pancreatitis

Pancreatic CA- acinar cell

Question 19

Most common location of subcutaneous fat necrosis in persons with pancreatitis/ pancreatic CA

Answer 19

Lower leg

Question 20

Rare autosomal recessive
Extreme paucity of fat - generalized muscular appearance
Children have voracious appetites
Increased height, advanced bone age, muscular hypertrophy and masculine habitus
Overall appearance is acromegalic
DM- appear often at puberty

Answer 20

Congenital generalized lipodystrophy

Question 21

Lipodystrophy:

Normal at birth bit at puberty subQ gradually lost from arms and legs

Fat gain in face, neck chest and abdomen (cushingoid appearance)

Answer 21

Familial partial lipodystrophy

Dunnigan type

Question 22

Most cases of acquired lipodystrophy are related to

Answer 22

Antiretroviral therapy

Question 23

Progressive fat disorder characterized by diffuse and progressive loss of subcutaneous fat that begins in the face and scalp progressing downward

Answer 23

Acquired partial lipodystrophy

Barraquer-Simons syndrome