Panniculitis is fibrous inflammation of the subcutaneous tissues, symptoms and treatment. Panniculitis is a rare disease. What kind of disease is Panniculitis?

Panniculitis is a pathology that is inflammatory in nature and affects the subcutaneous fatty tissue, which is fraught with its destruction and the appearance of pathological tissue in its place, i.e. connective tissue. The disease can be primary and secondary, and in half of the situations its spontaneous onset is noted, which is not preceded by any pathological processes. In addition, a number of predisposing sources are identified.

The clinical picture will differ somewhat depending on the type of pathology, but a common manifestation is the formation of nodular neoplasms in the subcutaneous fatty tissue, and they can be localized at different depths.

To make a correct diagnosis, a whole range of diagnostic measures is required, starting from studying the patient’s medical history and taking a biopsy of the tumor.

Treatment is performed only using conservative techniques, but will be dictated by the form of the disease.

Etiology

Almost half of the cases of such a disease are idiopathic in nature - this means that damage to the subcutaneous tissue develops spontaneously, without any pathological prerequisites. At the same time, the main risk group is female representatives in the age category from 20 to 50 years.

Among the predisposing factors that significantly increase the risk of developing such a disease, it is worth highlighting:

• any conditions leading to a decrease in the resistance of the immune system;
• leakage or ;
• presence or ;
• addiction to bad habits, in particular intravenous drug use;
• uncontrolled use of medications, for example, corticosteroids;
• prolonged hypothermia of the body;
• presence of excess body weight.

Despite the fact that clinicians in the field of dermatology know the causes and predisposing factors, the mechanism of occurrence of such a disease remains not fully understood. The most widespread theory is that the basis for inflammation of fatty tissue is the incorrect process of fat oxidation.

Classification

By its nature of formation, pathology is divided into:

• primary panniculitis;
• secondary panniculitis;
• idiopathic - also called Weber-Christian panniculitis.

The secondary variant of the disease has its own classification, which is why panniculitis can be:

• immunological- very often develops during the course of, and in children it can be part of the clinical picture of such an ailment as;
• lupus- based on the name, it becomes clear that it arises due to the deep form;
• enzymatic- formation is associated with the influence of pancreatic enzymes, the concentration of which in the blood increases with inflammatory damage to this organ;
• proliferative-cellular- the triggering factor may be leukemia or histiocytosis;
• cold- is a consequence of severe hypothermia. A distinctive feature is that dense nodes go away on their own within two or three weeks;
• steroid- very often forms in children a few weeks after the end of therapy with corticosteroids. This type is characterized by spontaneous healing, which does not require specific therapy;
• artificial- the source is the administration of narcotic or certain medicinal substances;
• crystalline- the trigger mechanism is or;
• associated with alpha-antitrypsin deficiency is a hereditary pathology in which the development of hemorrhages, etc. occurs.

Separately, it is worth highlighting mesenteric panniculitis - the rarest form of the disease. It differs in that it is a chronic nonspecific inflammatory process localized in the mesentery of the small intestine, in the omentum and retroperitoneal tissue. The reasons for its formation are unknown, but it has been established that it often affects children and representatives of the stronger half of humanity.

Depending on the form of formations that appear during such a course, they are distinguished:

• nodular panniculitis;
• infiltrative panniculitis;
• plaque panniculitis.

According to the nature of the course, panniculitis can be:

• sharp;
• subacute;
• chronic.

Symptoms

The main clinical sign of panniculitis is nodular neoplasms, which can be localized at different depths of subcutaneous fatty tissue. Most often they appear:

• in the upper and lower extremities;
• in the abdominal cavity;
• in the sternum;
• on the face.

The most rare lesions include the intestines and the cervical spine. After the resorption of the nodes, foci of atrophy may be present in the fatty tissue, which outwardly look like rounded zones of retraction of the skin.

The nodal form of the pathology is represented by:

• the appearance of nodes, which in volume can vary from 3 millimeters to 5 centimeters;
• focal location of nodes;
• redness of the skin located above the formations.

The plaque variant of the disease is accompanied by the following symptoms:

• merging of individual nodes into large conglomerates;
• the skin may acquire a pink, burgundy or burgundy-bluish tint;
• distribution of conglomerates over the entire area of ​​such fiber zones as the lower leg or shoulder, thigh or cervical spine;
• pronounced pain and swelling of the affected segment.

The infiltrative form of the disease has the following symptoms:

• melting of nodes;
• red or burgundy leather;
• the appearance of ulcerations in the area of ​​the opened nodular formation.

The mixed nature of the course of panniculitis develops quite rarely and is expressed in the transition of a nodular form to a plaque form, and then to an infiltrative one.

The spontaneous type of the disease may have the following symptoms:

• headache;
• slight increase in temperature;
• muscle and joint soreness;
• general weakness and malaise;
• nausea and vomiting - signs appear when the abdominal cavity is affected.

Mesenteric panniculitis is expressed in:

• pain in the epigastric region;
• low-grade fever;
• disruption of intestinal function;
• weight loss;
• well palpable formation in the peritoneum.

At the same time, it is worth noting that this variant of the disease can be completely asymptomatic.

Secondary panniculitis can be supplemented by symptoms of the underlying disease.

Diagnostics

If one or more of the above symptoms occur, you should seek help from a dermatologist, but the following may be involved in the process of diagnosing panniculitis:

• rheumatologist;
• nephrologist;
• gastroenterologist

First of all, the clinician should:

• get acquainted with the medical history - to establish the primary or secondary nature of the disease;
• analyze the patient’s life history to identify a factor that could influence the occurrence of the idiopathic type of disease or mesenteric panniculitis;
• conduct a thorough physical examination - aimed at studying the condition of the skin, palpation of the anterior wall of the abdominal cavity and measuring temperature;
• interview the patient in detail regarding the severity of the signs of the clinical picture.

Laboratory diagnostics involves the following:

• biochemistry of blood and urine;
• liver tests;
• blood test for pancreatic enzymes;
• blood culture for sterility;
• bacterial culture of discharge from a self-opened node.

The diagnosis can be confirmed using the following instrumental procedures:

• Ultrasound of the peritoneum, chest and kidneys;
• CT and MRI of the spine and limbs;
• biopsy of the nodular formation.

Thanks to the specific signs of panniculitis on ultrasound, it is possible to carry out a differential diagnosis, during which it is necessary to distinguish this disease from:

• erythema nodosum;
• lipomas and oleogranulomas;
• insulin lipodystrophy;
• changes that develop during the course of tuberculosis and diabetes mellitus.

Treatment

The scheme for neutralizing the disease will differ depending on its course, but in any case an integrated approach is required.

Nodular panniculitis can be eliminated using:

• non-steroidal anti-inflammatory drugs;
• antioxidants;
• vitamin complexes;
• injection of neoplasms with glucocorticoids;
• phonophoresis and UHF;
• magnetic therapy and laser therapy;
• ultrasound and ozokerite therapy.

When a plaque or infiltrative type of disease occurs, use:

• glucocorticosteroids;
• cytostatics;
• hepatoprotectors.

To treat panniculitis, which is of a secondary nature, it is sufficient to eliminate the underlying disease.

Surgical intervention for this disease, in particular for mesenteric panniculitis, is not advisable.

Prevention

To avoid the development of panniculitis, there are no special preventive measures; people only need to:

• to refuse from bad habits;
• Healthy food;
• take medications strictly as recommended by your doctor;
• avoid hypothermia;
• maintain normal body weight;
• strengthen the immune system;
• in the early stages of development, treat ailments that can lead to the formation of panniculitis.

In addition, do not forget about regular preventive examinations at a medical institution. The prognosis depends on the nature of the disease, location and number of nodes. However, a favorable outcome is often observed.

Panniculitis is a disease that leads to destructive changes in the subcutaneous fatty tissue. The most dangerous form of panniculitis is visceral; when this form develops, the fatty tissues of internal organs are affected.

There is a primary and secondary form of panniculitis. The primary form of the disease begins without any predisposing factors, that is, without a cause. This form most often occurs in women under forty who are overweight.

The secondary form of the disease has its own classification and occurs for a number of reasons.

Forms of panniculitis:

There are also several forms of panniculitis, depending on the type of skin lesions. There are plaque, nodular and infiltrative forms of fatty granuloma.

Knotty shape

The nodular form is manifested by the appearance of nodes with a diameter from a couple of millimeters to a couple of centimeters. This form acquires either a pinkish or bluish tint depending on the depth of its location. The nodes do not merge with each other.

Plaque

The plaque form occurs as a result of the fusion of nodes; such formations occupy large areas on the surface of the skin of the leg or thigh. Swelling of the limb may also be noted. The affected skin has a lumpy surface and a blue color.

Infiltrative form

The infiltrative form is characterized by fluctuations in nodules and a bright red color. When opened, a yellow substance is found, the consistency of which resembles foam.

Causes of panniculitis

• immunological panniculitis develops due to systemic vasculitis;
• enzymatic panniculitis occurs due to the action of enzymes produced by the pancreas and appears during the disease with pancreatitis;
• proliferative cellular panniculitis appears in patients with leukemia or lymphoma;
• lupus or lupus - a panniculitis form that occurs when lupus disease, their symptoms are almost the same;
• The cold form develops with hypothermia and is characterized by the appearance of dense nodules. Often found in children and adolescents, it occurs within a few days after hypothermia. The lesions are localized on the cheeks and chin. Women who ride horses also suffer from this disease, and areas of the hips and pelvis are affected. This form of panniculitis does not require special treatment, but it is recommended to use protective equipment against hypothermia;
• the crystalline form develops with renal failure or gout. Characterized by deposits of urates and calcifications in the subcutaneous tissue;
• artificial fat granuloma occurs at the injection site when various drugs and liquids are administered. This form is observed in people with mental disorders who inject various substances under their skin. Measures are taken based on the fluid that was injected into the subcutaneous tissue;
• the steroid form occurs in children as a reaction to steroid drugs. No special treatment is carried out, recovery occurs immediately after stopping the drugs;
• the hereditary form develops due to a deficiency of a substance called antipripsin.

Symptoms of panniculitis

Panniculitis manifests itself as nodular formations. Localized mainly on the legs, arms or stomach. After the panniculitis nodes are cured, skin depressions remain in their places.

In the case of the nodular form of panniculitis, separately located nodes with a red tint on the surface appear in the subcutaneous tissue.

The plaque form of panniculitis is characterized by the presence of nodes that, fused together, form a tuberous area. The skin color of such formations varies from pink to purplish-blue. Such areas sometimes occupy the entire area of ​​the lower leg or shoulder, compressing blood vessels and nerve bundles, thus causing pain and swelling.

The infiltrative form occurs with the disintegration of nodes, then in the area of ​​the blue node, a fluctuation appears. When such nodes are opened, a thick yellow liquid resembling a purulent substance is released, but it is not pus.

It is also possible to transition from the nodular form of panniculitis to the plaque form and then to the infiltrative form.

With spontaneous infection with panniculitis, changes are observed in the subcutaneous fatty tissue, which may not be accompanied by disruptions in the general condition of the body. But most often, at the initial stage of the disease, symptoms appear, for example, weakness or headache, and an increase in body temperature is also observed.

Panniculitis can have an acute, subacute or recurrent form of development. Development time ranges from two or three weeks to two years.

The acute form of panniculitis is manifested by high fever and pain in the joints and muscles, impaired functioning of the kidneys and liver. During treatment, the patient's condition continues to deteriorate and ends in death within a year.

The patient's subacute condition is more benign, but liver dysfunction is observed and is accompanied by fever.

The most benign state of panniculitis is recurrent or chronic. Relapses of the disease are severe, the general condition of the patient does not change, but this period is replaced by a long period of remission.

Diagnosis of panniculitis

Panniculitis is diagnosed at an appointment with a dermatologist; a rheumatologist and nephrologist, as well as a gastroenterologist, also help him make a diagnosis. A biochemical analysis of urine and blood is prescribed. Using ultrasound, the abdominal cavity, kidneys and liver, and pancreas are examined to identify nodes of visceral panniculitis. A blood test for sterility helps to exclude the septic nature of the disease. Bacteriological examination of the yellow contents, which are released when the node is opened, helps to distinguish the infiltrative version of panniculitis from an abscess.

An accurate analysis of panniculitis is determined by a biopsy of the node. Histological examination determines inflammatory infiltration, replacement of fat cells with connective tissue. Immunological testing diagnoses lupus panniculitis.

Treatment of panniculitis

Treatment of panniculitis takes into account etiopathogenetic factors. In acute panniculitis, which is accompanied by fever, pain in muscles and joints, changes in blood composition, bed rest and benzylpenicillin are prescribed. For severe paniculitis, the drug prednisolone is used. For immunological forms of panniculitis, treatment with antimalarials begins.

A number of vitamins are also used, such as A, E, C, P. The treatment regimen for panniculitis is selected depending on the course and form of the disease. Also, treatment must be comprehensive.

The chronic form of nodular panniculitis is treated with anti-inflammatory drugs and a complex of vitamins. The nodes are also injected with drugs that contain glucocorticosteroids.

The plaque and infiltrative form is treated with glucocorticosteroids and cytostatics. Hepaprotectors help the liver function. Physiotherapy is also carried out for any form.

Quite often, along with treatment with medications, treatment with folk remedies is also used. Herbal ingredients are used, for example, compresses from raw beets on the affected areas of the skin, compresses from mashed hawthorn fruits, and also lotions from mashed plantain leaves. Such compresses relieve swelling and have an anti-inflammatory effect. It is good and beneficial for the body to drink herbal teas based on echinacea and rose hips.

Relapses of panniculitis are often associated with intercurrent infections, so during such a period supervision by a dermatologist and therapist will be required.

There is practically no prevention for this disease, since it does not have a clear pattern of development of primary panniculitis. But for the second form of development of panniculitis, the underlying disease is treated.

The chronic form and subacute form have favorable prognoses for recovery, in contrast to the acute form, which is unpredictable.

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Panniculitis is a progressive disease that affects adipose tissue in the subcutaneous tissue or internal organs, resulting in the destruction of fat cells and their replacement with connective tissue. As a result, infiltrates, nodes or plaques form in tissues and organs. The tissues of the liver, kidneys, pancreas, omentum and retroperitoneal region may be affected.

In half of the cases, panniculitis is considered to be spontaneous, Weber-Christian panniculitis, or an idiopathic process, which most often occurs in women between 20 and 50 years of age. The remaining half of the cases are due to manifestations of secondary panniculitis, which develops as part of a systemic pathology, skin disease, immunological changes in the body and inflammation provoked by external factors - medications, prolonged cooling.

The basis for the development of panniculitis is defects in the process of lipid peroxidation, but today clear mechanisms of the occurrence and development of the process have not yet been discovered.

Forms of panniculitis

There are systemic and local (in the subcutaneous tissue) panniculitis. Based on the form of changes that occur, nodular, plaque or infiltrative processes are divided. Mesenteric panniculitis and Weber-Christian panniculitis are considered particularly common.

Symptoms

With mesenetrial panniculitis, the mesentery thickens as a result of the inflammatory process in it. Often the vault of the mesentery of the small intestine is involved in inflammation. Usually occurs in men, less often in children. Symptoms can be non-specific and usually include moderate to severe attacks of abdominal pain, nausea, vomiting and general weakness. The diagnosis is usually revealed on CT scan as dense fatty masses with fibrosis.

Weber-Christian panniculitis occurs more often in women, and compactions occur in the subcutaneous tissue, especially at the sites of burns, exposure to chemicals, and cuts. General and local symptoms depend on the form of the disease. Nodes appear on the hips, trunk and limbs. They are initially dense, then become softer, and compactions may appear along the edges. They move easily relative to the skin, have a normal or pale blue color, can reach the size of a pea and merge with each other. May be painful.

Gradually they can resolve. In place of the nodes, zones of atrophy remain with skin retraction and pigmentation. Sometimes the nodes open with the flow of fatty masses and the formation of an ulcer. Symptoms occur in attacks with relapses every few months or years.

Diagnostics

For subcutaneous panniculitis, histological confirmation of the diagnosis is necessary. Mesenteric panniculitis is often diagnosed by CT scan or surgery.

Treatment

For mesenteric panniculitis, treatment is surgical. A laparotomy is performed with excision of the damaged areas and a biopsy.

Treatment of the subcutaneous form of panniculitis is carried out comprehensively. When prescribing treatment, they proceed from the form and distribution of the process. Anti-inflammatory drugs and antioxidants are used, and areas are injected with glucocorticoid hormones. A good effect is observed from physiotherapy - phonophoresis with hydrocortisone, UHF, magnetic therapy, laser therapy or ultrasound.

In severe recurrent cases, cytostatic treatment is used. To protect the liver, hepatoprotectors are used, treatment of pancreatitis, restoration of impaired fat metabolism. The prognosis is generally favorable.

Panniculitis
Panniculitis is the infiltration of the hypodermis by inflammatory or neoplastic cells. Clinically, panniculitis is manifested by a more or less deeply located compaction, sometimes protruding above the surface of the skin. In addition, the following symptoms are observed: erythema, ulcers, fever, skin tension and soreness. There are also compactions and nodes without signs of inflammation.
The main forms of panniculitis 1. Septal panniculitis:
1) erythema nodosum;
2) subacute nodular migratory panniculitis (scleroderma-panniculitis).
2. Lobular or mixed panniculitis.
3. Vasculitis and connective tissue diseases:
1) nodular vasculitis (erythema induratum);
2) lupus panniculitis;
3) other types of connective tissue panniculitis.
4. Metabolic disorders:
1) softening damage/fat compaction;
2) sclerema of newborns;
3) subcutaneous fat necrosis of newborns;
4) pancreatic fat necrosis (enzymatic);
5) a-1-antitrypsin deficiency panniculitis.
5. Traumatic panniculitis.
6. Infectious panniculitis.
7. Malignant tumors and panniculitis.
8. Lipodystrophy. Currently, there is no single, universally accepted classification; however, there is a tendency to group diseases according to histopathological features and etiology. Septal panniculitis is characterized by inflammatory changes mainly in the connective tissue septa between the fat lobules, while lobular panniculitis is characterized by a predominant lesion of the fat lobules themselves. Lipodystrophy may be the final stage of inflammatory, traumatic, metabolic or hormonal changes in hypodermal fat.
Erythema nodosum. Erythema nodosum is characterized by erythematous tense nodules predominantly in the pretibial areas (although any localization is possible), developing as a result of a hypersensitivity reaction to certain antigens. Most often this is an acute process, but it can also be chronic. Some authors regard subacute nodular migratory panniculitis (Villanova disease) as a chronic variant of erythema nodosum. Erythema nodosum is a delayed-type hypersensitivity reaction to a wide range of antigens. The most common causes of erythema nodosum are streptococcal infection (streptococcal pharyngitis) and medications (especially oral contraceptives, possibly halogen-containing drugs). Less commonly, erythema nodosum occurs in tuberculosis, deep mycoses (coccidioidomycosis and blastomycosis), yersiniosis, sarcoidosis, ulcerative colitis, enteritis, and leukemia.
How to perform a biopsy of erythema nodosum? The biopsy sample is taken from the central part of the node with maximum coverage of deep-lying tissues (the biopsy sample must contain subcutaneous tissue). It is preferable to perform an incisional biopsy with a wide coverage of the hypodermis.
Typical histological changes are characterized predominantly by septal panniculitis with the penetration of inflammatory cells into the fat lobules and the formation of infiltrates in the form of lakes. The cells are represented mainly by lymphocytes, neutrophils and/or eosinophils. Perivascular infiltrates are often found, but true vasculitis is not detected. In chronic forms, microgranulomas develop in the connective tissue septa.
How to treat erythema nodosum? The basis is the treatment of the disease that caused erythema nodosum. Salicylates, non-steroidal anti-inflammatory drugs, potassium iodide (especially in chronic forms) are used as auxiliary agents, and bed rest is prescribed.
Nodular vasculitis- This is a form of panniculitis, most often localized on the posterior surface of the lower extremities. Ulceration of the lesions is possible. Initially, the disease was regarded as tuberculosis (erythema induratum of Bazin), but in recent years this dermatosis has been considered idiopathic or associated with other types of infection.
Nodular vasculitis develops as a result of the formation of immune complexes to various antigens. Mycobacterial infection is one suspected agent; recently, mycobacterial DNA was identified in lesions using a polymerase reaction.
Nodular vasculitis is a lobular panniculitis with a mixed, often granulomatous infiltrate. Vasculitis of medium-sized arteries or veins is typical, but sometimes a dense infiltrate does not allow changes in the vessels to be determined, and additional biopsy sections are required. Caseous necrosis occurs in half of the cases and not only with tuberculosis.
Differential diagnosis nodular vasculitis. With polyarteritis nodosa and superficial thrombophlebitis, vasculitis of medium-sized vessels is noted in the subcutaneous tissue.
In both cases, inflammatory changes are “attached” to the vessels, and, as a rule, a pronounced inflammatory infiltrate of fat lobules does not obscure them. The general clinical picture of systemic polyarteritis nodosa is characterized by hypertension, kidney and central nervous system damage; with superficial migrating thrombophlebitis, malignant tumors of internal organs are detected. According to some data (J.V. Patterson), classic nodular vasculitis is rare, but its occurrence cannot be ruled out due to the increasing incidence of tuberculosis.
Treatment of nodular vasculitis. First of all, it is necessary to treat the infectious process, especially tuberculosis. Symptomatic therapy includes bed rest and anti-inflammatory drugs. It is necessary to exclude factors that provoke the development of the disease, in particular smoking.
Lupus panniculitis, also called lupus profundus, is characterized by erythematous or normal skin-colored subcutaneous nodules. Lesions in this form, unlike those in other panniculitis, are more often localized on the face, the outer surface of the upper extremities, shoulders, and torso. Sometimes there are changes characteristic of discoid lupus (follicular horn plugs or epidermal atrophy).
In typical cases, this is a mixed septal-lobular panniculitis, characterized by focal or diffuse and perivascular infiltrates, in which lymphocytes predominate. Clusters of lymphocytes surrounded by plasma cells or lymphoid follicles, as well as mucin deposits and hyalinization, are sometimes seen. In half of the cases, changes in the epidermis characteristic of cutaneous lupus erythematosus are detected.
How important is it to diagnose lupus panniculitis? Panniculitis can be a manifestation of cutaneous or systemic lupus erythematosus. However, due to atypical clinical features, a final diagnosis is sometimes made after several months or years. Early biopsy and direct RIF of lesions help in the diagnosis of lupus erythematosus and allow initiation of appropriate therapy.
Sclerema newborns develops mainly in premature infants and is characterized by thickened, cold, board-like skin; Early death is often observed.
Necrosis subcutaneous tissue develops several weeks after birth as firm, relatively discrete nodules. The prognosis for life and resolution of the process in this case is more favorable.
Are sclerema of newborns and necrosis of subcutaneous tissue of newborns a reflection of the same process? No. With these diseases, varying degrees of severity of sclerosis of the subcutaneous tissue of newborns are noted.
Are the microscopic signs of sclerema and necrosis of the subcutaneous tissue of newborns similar? Both diseases are characterized by needle-shaped gaps in lipocytes, apparently formed in place of dissolved triglyceride crystals during tissue processing. With sclerema, thickening of the fibrous septa and mild inflammation are noted, with necrosis of the subcutaneous tissue - lobular panniculitis.
What are the causes of these diseases? In neonatal fat, the ratio of saturated and unsaturated fatty acids is increased, which leads to an increase in the melting point and the formation of areas of fat hardening. These changes, in combination with other possible metabolic defects, lead to crystal formation, fat necrosis, and inflammation due to vascular compromise or injury.
Pancreatic fat necrosis. The disease manifests itself as subcutaneous nodes on the lower extremities or other areas, developing against the background of acute pancreatitis, pancreatic carcinoma, traumatic pancreatitis and pancreatic pseudocysts. The process may involve fat from internal organs. The main role in the development of the disease is played by circulating amylase and/or lipase, which directly affects the subcutaneous tissue. The basis of therapy is the treatment of pancreatic diseases.
Are there characteristic histological features of pancreatic fat necrosis? These signs are pathognomonic and are characterized by the remains of lipocytes with thick, indistinct walls (ghost cells) and accumulations of basophilic material, which is a product of the saponification of fat with calcium salts (saponification).
What is the role of a-1-antitrypsin (proteinase inhibitor) deficiency in the development of panniculitis? Since the mid-1970s. It has become apparent that patients with proteinase inhibitor deficiency, especially those with severe forms and those with the PiZZ phenotype, are prone to the development of painful subcutaneous ulcerating nodules. It has been established that in such patients, due to exposure to provoking factors (for example, trauma), non-stop activation of complement, inflammation, and damage to endothelial cells and tissues begin. Microscopic changes are characterized by diffuse neutrophilic infiltration of the reticular dermis, liquefaction necrosis of the dermis and fibrous septa, leading to separation of fat lobules. Treatment is with dapsone and systemic corticosteroids; It is planned to include a proteinase inhibitor in the regimen in the near future.
What types of injuries cause panniculitis? Numerous types of trauma (both accidental and intentional) can cause the formation of painful subcutaneous nodules: cold injuries, injection of foreign substances (mineral oils, medications), blunt force trauma. Each type is characterized by specific histological features, therefore, for traumatic panniculitis, a biopsy is indicated. Polarization microscopy is a simple method for detecting foreign material in tissue sections. The success of therapy depends on the detection and elimination of the cause that caused panniculitis.
How does infection cause panniculitis? Panniculitis can develop with localized and generalized infection caused by gram-positive and gram-negative bacteria, mycobacteria Nocardia, Candida, Fusarium. Immunosuppressed individuals have an increased risk of developing infectious panniculitis. Microscopic signs are varied and may resemble those of other panniculitis. However, septal lobular lesions, neutrophilic infiltration, vascular proliferation, hemorrhage, and sweat gland necrosis suggest an infectious nature of the disease. Special stains and cultures help make a definitive diagnosis and guide appropriate antimicrobial treatment.
What is the role of malignant tumors in the development of panniculitis? Malignant infiltrates, manifested by nodes, are similar to various types of panniculitis. The situation is also complicated by the possible addition of a malignant component to the inflammatory changes. Thus, the diagnosis is established on the basis of biopsy data. Histological changes characteristic of malignant processes are characterized by uniform cell populations and/or cellular atypia, the arrangement of cells between collagen fibers in one line and minor damage to the connective tissue of the face in the form of dense cellular infiltration. Panniculitis-like lesions are characteristic of poorly differentiated carcinoma, lymphoma, multiple myeloma and leukemia.
Lipodystrophy. Lipodystrophy is manifested by indentation or, less commonly, thickening of the skin caused by changes in the subcutaneous tissue.
Lipoatrophy occurs in various forms, some of them are idiopathic, others are associated with syndromes of insulin-resistant diabetes mellitus, complement pathology, and are also caused by the use of injectable corticosteroids and insulin. Probably, in most cases, lipoatrophy represents post-inflammatory changes in some forms of panniculitis.
Lipohypertrophy develops with repeated injections of highly purified porcine insulin. Microscopically, lipoatrophy is characterized by the “collapse” of fat lobules due to the formation of lipocytes of various sizes and numerous capillaries in the mucinous stroma of the dermis. With lipohypertrophy, enlarged lipocytes are found invading the middle part of the dermis. To correct lipoatrophy, plastic surgery methods are used.
Weber-Christian disease, or febrile non-suppurating panniculitis recurrent, was first described in 1925 and 1928, however, to this day many cases of panniculitis receive this controversial name. Recent studies have made it possible to more clearly define the signs of various forms of panniculitis.
As a result, only some forms are classified as nonspecific panniculitis.
What is the approach to making a diagnosis in an “unclear” case of panniculitis?
1. A thorough history and examination are of greatest importance; special consideration of the localization of rashes; due to possible drug injections, infection or injury.
2. Laboratory tests include culture diagnostics (to exclude streptococcal pharyngitis in erythema nodosum), determination of antinuclear antibodies (to exclude lupuspanniculitis), determination of a-1-Antitrypsin level (to detect panniculitis caused by proteinase inhibitor deficiency).
3. Skin biopsy plays a leading role; histological examination is complemented by various methods of biopsy staining and polarization microscopy.
4. Immunohistochemical examination is indicated if there is a possibility of developing malignant processes; X-ray microanalysis is used in traumatic panniculitis to identify foreign bodies.

Panniculitis or fatty granuloma is a disease that leads to necrotic changes in the subcutaneous fatty tissue. The disease is prone to relapse.

As a result of the inflammatory process during panniculitis, fat cells are destroyed and replaced by connective tissue with the formation of infiltrates of plaques or nodes.

The most dangerous is the visceral form of panniculitis, which affects the fatty tissue of internal organs - kidneys, pancreas, liver, etc.

Reasons for the development of the disease

These diseases most often affect women of reproductive age.

In approximately half of patients, fatty granuloma develops spontaneously, that is, against a background of relative health. This form is more common in women of reproductive age and is called idiopathic.

In the remaining 50% of patients with panniculitis, inflammation of adipose tissue develops as one of the symptoms of a systemic disease - sarcoidosis, lupus erythematosus, etc.

The cause of panniculitis may be immune disorders, exposure to cold, or a reaction to certain medications.

Doctors believe that the development of fatty granuloma is based on a pathological change in metabolic processes in adipose tissue. However, despite many years of research and study of panniculitis, to date it has not been possible to obtain a clear understanding of the mechanism of development of the inflammatory process.

Classification of forms of the disease

In dermatology, primary and secondary forms of fatty granuloma are distinguished.

In the first case, panniculitis develops without the influence of any factors, that is, for unknown reasons. This form is called Weber-Christian syndrome and most often occurs in women under 40 years of age who are overweight.

Secondary panniculitis occurs for various reasons, which made it possible to develop a specific system for classifying forms of the disease.

The following forms of panniculitis are distinguished.

• Immunological panniculitis. The disease develops against the background of systemic vasculitis. Sometimes this variant of fatty granuloma is detected in children as a form of erythema nodosum.
• Fermentative panniculitis. The development of inflammation is associated with the action of enzymes produced by the pancreas. As a rule, it manifests itself against the background of pancreatitis.
• Proliferative cell fatty granuloma develops in patients with lymphoma, histiocytosis, leukemia, etc.
• Lupus panniculitis is one of the manifestations of lupus erythematosus, which occurs in an acute form.
• Cold panniculitis develops as a local reaction to hypothermia. It manifests itself by the appearance of dense nodes, which spontaneously disappear after a few weeks.
• Crystalline panniculitis is a consequence of gout or kidney failure. Develops due to the deposition of urates and calcifications in the subcutaneous tissue.
• Artificial fat granuloma develops at the injection site after the administration of various drugs.
• The steroid form of panniculitis often develops in children as a reaction to treatment with steroid drugs. No special treatment is required, the inflammation goes away on its own after stopping the medication.
• The hereditary form of panniculitis develops due to a deficiency of a certain substance - A1-antipripsin.

In addition, there is a classification of forms of panniculitis depending on the type of lesions on the skin. There are plaque, nodular and infiltrative forms of fatty granuloma.

Clinical picture

Panniculitis can occur in acute, recurrent or subacute form.

1. The acute form of fatty granuloma is characterized by a sharp development, deterioration of the patient’s general condition, and disturbances in the functioning of the kidneys and liver are often observed. Despite treatment, relapses follow one after another, each time the patient’s condition worsens. The prognosis for acute panniculitis is extremely unfavorable.
2. Fatty granuloma, which occurs in a subacute form, is characterized by milder symptoms. Timely treatment usually has a good effect.
3. The most favorable form of the disease is considered chronic or recurrent panniculitis. In this case, exacerbations are not too severe, and long remissions are observed between attacks.

The symptomatic picture of panniculitis depends on the form.

Primary (idiopathic) form

The main symptoms of spontaneous (primary) fatty granuloma are the appearance of nodes located in the subcutaneous fat. Nodes can be located at different depths. In most cases, nodes appear on the legs or arms, less often on the stomach, chest or face. After the destruction of the node, areas of atrophy of adipose tissue are observed in its place, which outwardly look like retraction of the skin.

In some cases, before the appearance of nodes, patients experience symptoms characteristic of the flu - weakness, muscle pain, headache, etc.

Plaque form

Plaque panniculitis is manifested by the formation of multiple nodes, which quickly grow together to form large conglomerates. In severe cases, the conglomerate spreads to the entire area of ​​the subcutaneous tissue of the affected area - shoulder, thigh, lower leg. In this case, the compaction causes compression of the vascular and nerve bundles, which causes swelling. Over time, due to impaired lymph outflow, lymphostasis may develop.

Nodal form

With nodular panniculitis, nodes with a diameter of 3 to 50 mm are formed. The skin over the nodes takes on a red or burgundy hue. The nodes are not prone to fusion in this variant of the disease.

Infiltrative form

In this variant of the development of panniculitis, melting of the resulting conglomerates with the formation of fluctuations is observed. Externally, the lesion looks like phlegmon or an abscess. The difference is that when the nodes are opened, there is no discharge of pus. The discharge from the node is a yellowish liquid with an oily consistency. After opening the node, an ulceration forms in its place, which does not heal for a long time.

Visceral form

This variant of panniculitis is characterized by damage to the fatty tissues of internal organs. Such patients develop pancreatitis, hepatitis, nephritis, and characteristic nodes may form in the retroperitoneal tissue.

Diagnostic methods

Ultrasound of internal organs is also prescribed for diagnosis.

Diagnosis of panniculitis is based on studying the clinical picture and conducting tests. The patient should be referred for examination to specialists - nephrologist, gastroenterologist, rheumatologist.

The patient will need to donate blood for biochemistry, liver tests, and conduct a study of enzymes produced by the pancreas. As a rule, an ultrasound scan of internal organs is prescribed.

To exclude the septic nature of the lesion, the blood is checked for sterility. To make an accurate diagnosis, a biopsy of the node is performed.

Treatment regimen

Treatment of panniculitis is selected individually, depending on the course and form of the disease. Treatment must be comprehensive.

As a rule, patients with nodular panniculitis, which occurs in a chronic form, are prescribed:

• Non-steroidal anti-inflammatory drugs.
• Vitamins.
• Injection of nodes with drugs containing glucocorticosteroids.

For infiltrative and plaque forms, glucocorticosteroids and cytostatics are prescribed. To support the liver, taking hepaprotectors is indicated.

For all forms, physiotherapy is indicated - phonophoresis, UHF, laser therapy. Ointments with corticosteroids are used locally.

With secondary fatty granuloma, it is necessary to treat the underlying disease.

Treatment with traditional methods

Additionally, herbal medicine can be used. Useful for panniculitis:

• Compresses from raw beets to the affected area.
• Compresses from crushed hawthorn fruits.
• Compresses made from crushed plantain leaves.

It is useful to drink herbal teas prepared on the basis of echinacea, rose hips, and eleutherococcus for general strengthening of the body.

Prognosis and prevention

Since the mechanism of development of primary panniculitis is unclear, there is no specific prevention of this disease. To prevent a secondary form of the disease, it is necessary to actively and persistently treat the underlying disease.

In chronic and subacute forms of the disease, the prognosis is favorable. In the acute version of the disease, it is extremely doubtful.