Panniculitis Dan

Question 1

What are causes of septal panniculitis?

Answer 1

without vasculitis - SEEN
Scleroderma/ morphoea profunda
Erythema Nodosum + EN migrans
Eosinophilic panniculitis = small print
NLD, GA  

with vasculitis - PAN CT
Polyarteritis nodosa (PAN)
Cutaneous small vessel vasculitis
Superficial or migratory Thrombophlebitis

Question 2

What is septal panniculitis differential?

Answer 2

ASPEN migration + infection

Alpha1 antitrypsin deficiency (usually lobular)
Scleroderma/ morphoea profunda
Polyarteritis nodosa (rarely)
Erythema nodosum (most common)
Necrobiosis lipoidica or deep GA
Migration - migratory thrombophlebitis (rarely)
Infective causes – bacteria, myco, fungi, helminths

Question 3

What are causes of lobular panniculitis?

Answer 3

without vasculitis - IF CcLlAP
Idiopathic Nodular panniculitis (Weber-Christian disease)
Fat necrosis causes
o	Cold panniculitis
o	Nodular cystic fat necrosis
Cytophagic histiocytic panniculitis
Crystal panniculitides (include the main causes in Kids)
o	Sclerema neonatorum
o	SC fat necrosis of newborn
o	Post-steroid panniculitis	
o	Gout/ Oxalosis
o	Drugs (injected)
o	Calcifying panniculitis (panc, lupus, crystal, alpha1, calciphylaxis)
o	Factitial panniculitis
Lupus profundus
Lymphomatous/malignant causes
Alpha1 antitrypsin deficiency (usually mainly lobular but can be septal or mixed) 
Pancreatic panniculitis

with vasculitis - CLONE
Cutaneous Crohn’s associated panniculitis
Lepra reactions; Lucio’s phenomenon or Erythema nodosum leprosum (NOT type 1 rcn)
Oedematous scarring vasculitic panniculitis
Neutrophilic panniculitis
Erythema induratum (Bazin or Whitfield types)

Question 4

What are the causes of a mixed or either panniculitis?

Answer 4

take music CLIPS for a MIX tape
Connective tissue (lipoatrophic) panniculitis (dermatomyositis, RA, Hashimotos) 
Lipodermatosclerosis
Infective panniculitis
Physical or factitious panniculitis
o	Trauma
o	Oil granuloma
o	Sclerosing lipogranuloma
Sarcoidosis

Question 5

What are causes of a lobular/mixed panniculitis?

Answer 5

SKEPTICALLL
Sarcoidosis - subcutaneous
Kids - Sclerema neonatorum, Fat necrosis of the newborn (needle-shaped clefts within lipocytes); sclerema is a screamer - bad prognosis; fat nec has good prog
Erythema induratum (Bazin or Whitfield)(w/ vasculitis)
Pancreatitis (necrosis is early feature)
Traumatic - blunt trauma, injectable substances (oil, DA etc), cold panniculitis, sclerosing lipogranuloma
Idiopathic Nodular panniculitis
Infectious
Calcifying panniculitides - pancreatic, crystal (gout, oxalosis), alpha1 antitrypsin deficiency, calciphylaxis
AI - Dermatomyositis, Lupus profundus, RA, Hashimotos, Crohns (w/ vasculitis)
Lipodermatosclerosis
Lipodystrophies (Cold panniculitis, Nodular cystic fat necrosis)
Lepra reactions; Lucio’s phenomenon or Erythema nodosum leprosum (NOT type 1 rcn) (w/ vasculitis)

Question 6

Which panniculitides are most associated with calcium deposition?

Answer 6

Pancreatic panniculitis (dystrophic)
Alpha 1 antitrypsin deficiency panniculitis (dystrophic)
Lupus profundus (dystrophic)
Subcutaneous fat necrosis of the newborn (metastatic – high calcium)
crystal panniculitides (gout, oxalosis)(dystrophic)
\+/- Calciphylaxis (see below)