Panniculitis Flashcards
Panniculitis
inflammation of the subcutaneous tissue, can be divided by location either septal or lobular. Easily mistaken for cellulitis
Erythema Nodosum
most common form of panniculitis, females more common in 30s-40s, delayed response to an antigen
Antigens for EN
bacteria, viruses, chemicals… can also be idiopathic (most common) in 55% of cases
Common causes of EN
upper resp strep infections, bacterial gastroenteritis, coccidiodomycosis, Sarcoidosis, IBD
drugs causing EN
estrogen, sulfa, PCN
Clinical features of Erythema Nodosum
tender erythem nodules, bilaterally on shins, thighs, forearms. No ulcers. Lesions last days to weeks leaving bruise discoloration that eventually resolves
Recurrence with EN
33% can recur, common annually with the idiopathic kind
Chronic forms of EN
subacute nodular migratory panniculitis, erythema nodosum migrans
lesion spreading in EN
start as a classic nodule and can migrate centrifugally (away from the center of the body). they demonstrate central clearing
Pathology EN
prominent neutrophils, Miescher microgranulomas may be present - collection of macrophages
Tx EN
assess med list, if they are on one commonly a/w EN, D/c it. Treat underlying diseases but will not shorten course of EN, bedrest w legs elevated, NSAIDs for pain
Potassium Iodide
adults 150mg TID and taper up, bitter taste, dilute in juice, s/e nausea, headache, urticaria. can affect thyroid. Not for pregnancy will lead to goiter
Alpha 1-Antitrypsin Deficiency
genetic error in alpha antitrypsin which controls proteases, activates lymphocytes and macrophages that attack subcutaneous fat –> panniculitis
Pathogenesis of low alpha 1 antitrypsin
activates lymphocytes and macrophages that attack subcutaneous fat. Can be caused by trauma or in post partum patients
Alpha-1 Antitrypsin Deficiency symptoms
very large, erythematous tender nodules and plaques on the lower legs, flank, buttocks, thighs. Ulcerations occur - deep, necrotic. Oily discharge. –> scarring, atrophy
Pathology Alpha-1 Antitrypsin Deficiency
neutrophillic inflammation of the panniculus –> necrosis, destruction of fat lobules, “skip factors” where fat lobules are next to necrotic areas
ddx Alpha-1 Antitrypsin Deficiency
ulcerated areas can appear as PG, trauma, infection, pancreatitis, erythema induratum
Alpha-1 Antitrypsin Deficiency tx
replacing alpha 1 antitrypsin via infusion, 60mg/kg weekly x 3-7 weeks, plasma exchange, no alcohol
Erythema Induratum
panniculitis commonly associated with tuberculosis but can be caused by drugs or other infections, seen in females 30-40
Pathogenesis Erythema Induratum
type 4 cell mediated response to an antigen like TB, hep C, meds like propylthiouracil (PTU)
Erythema Induratum clinical features
tender nodules that are erythematous to violaceous, common on the calves, commonly ulcerate, heals with a scar
Pathology Erythema Induratum
inlammation of neutrophils, lymphocytes, macrophages, giant cells, vasculitis, possibly necrosis
Erythema Induratum tx
treat the underlying condition if it can be identified, supportive socks, oral steroids, NSAIDs, potassium iodide
Lipodermatosclerosis
sclerosing type of panniculitis on the lower legs of middle ages to older females
pathogenesis lipdermatosclerosis
venous insuff, leaking fibrinogen from capillaries, fibrin cuffs around vessels interfering with o2 exchange
lipdermatosclerosis clinical features – acute phase
increase warmth, pain and induration of the medial lower leg above the malleolus or the pannus of the abdomen
lipdermatosclerosis – clinical features, chronic phase
sclerosis of the dermis and subcutaneous tissue that may be demarcated from adjacent normal skin, lower leg may have an “inverted wine bottle”
lipdermatosclerosis tx
leg elevation, consistent compression to control the leg edema
Pancreatic Panniculitis
very rare, 2% of those with pancreatitis, felt to be autoimmune but the panc. enzymes – lipase, amylase, trypsin, interplay with fat necrosis. precedes abd symptoms
Pancreatic Panniculitis clinical features
subcutaneous nodules that are erythematous, edematous and painful on the legs usually but can be on the arms, chest, abd, scalp. lesions become purulent, ulcerate and discharge an oily substance
Schmids Triad with Pancreatitis Panniculitis
subcutaneous nodules, polyarthritis, eosinophilia
Pathology Pancreatitis Panniculitis
bx must be deep enough to contain the subcutaneous fat, early will have fat necrosis and ghost cells, late will show lipoatrophy
dx feature characteristic of pancreatitis panniculitis
pancreatitis, ghost cells
tx Pancreatitis Panniculitis
resolve pancreatitis
Infection-Induced Panniculitis
Directly induced by an infectious agent like bacteria, mycobacteriam, borrelia, fungus, more common in immunocompromised
Pathogenesis infection induced panniculitis
direct inoculation of the infectious agent
clinical features Infection-Induced Panniculitis
local edema, erythema, fluctiant nodules that may ulcerate and drain,common on legs and feet
pathology Infection-Induced Panniculitis
neutrophils, necrosis of lymphocytes, eccrine gland involvement, c&s is needed
tx Infection-Induced Panniculitis
antimicrobials based on the c&s
Traumatic Panniculitis
due to external injury 4 types: cold panniculitis, sclerosing
