23- Subcutaneous Fat Flashcards
Most common inflammatory panniculitis
Erythema nodosum
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
Acute erythema nodosum
Acute erythema nodosum is frequently associated with these infections
Streptococcal
TB
GIT- yersinia salmonella shigella
EN is also seen with IBD, more often with this one than the other
Crohns
Sarcoidosis may also occur with EN and may present with fever, cough, joint pain and hilar adenopathy.
This syndrome is called
LΓΆfgren syndrome
EN may also be induced by medication. The most common are
Oral contraceptives
Hormone replacement therapy
Chronic EN is distinguished from acute EN by
Unilateral or asymmetric involvement
Tends to occur in older women
Not associated with systemic symptoms except arthralgia
Painless or less tender
Management of erythema nodosum
Rest, elevation, identify trigger Throat culture, ASO titer Travel and exposure history NSAID, restriction of physical activity SSKI (saturated solution of K iodide)
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
Nodular vasculitis/ erythema induratum
Erythema induratum is clinically similar to nodular vasculitis but it differs due to
TB as precipitating factor in erythema induratum
Treatment for erythema induratum and nodular vasculitis
EI- TB treatment
NV- SSKI
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
Lipodermatosclerosis
Biopsy should be done in patients with lipodermatosclerosis
True or false
False
-wounds heal poorly and may lead to chronic leg ulcers
Treatment for lipodermatosclerosis/sclerosing panniculitis
Compression stockings
Elevation
+ Intralesional triamcinolone and ultrasound therapy
Pentoxyphylline 400-800mg TID
Surgical tx of varicosities
Subcutaneous fat necrosis may be accompanied by elevation of
Calcium
Hypercalcemia
Severest and rarest disorder of physical panniculitides
Affects premature neonates who are seriously ill or have profound hypothermia
Sclerema neonatorum
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
Sclerosing lipogranuloma
Subcutaneous fat necrosis is most commonly associated with this disease
Pancreatitis
Pancreatic CA- acinar cell
Most common location of subcutaneous fat necrosis in persons with pancreatitis/ pancreatic CA
Lower leg
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
Congenital generalized lipodystrophy
Lipodystrophy:
Normal at birth bit at puberty subQ gradually lost from arms and legs
Fat gain in face, neck chest and abdomen (cushingoid appearance)
Familial partial lipodystrophy
Dunnigan type
Most cases of acquired lipodystrophy are related to
Antiretroviral therapy
Progressive fat disorder characterized by diffuse and progressive loss of subcutaneous fat that begins in the face and scalp progressing downward
Acquired partial lipodystrophy
Barraquer-Simons syndrome