Panniculitis

A nodular panniculitis is a descriptive term for panniculitis secondary to many causes.
Lesions are typically ill-defined, subcutaneous masses up to many centimeters across. Following destruction of the subcutaneous fat, depressions are common. Ulceration can also occur.

• alpha1-antitrypsin inhibitor deficiency. Severe panniculitis can result from the deficiency of this protease inhibitor. Extensive areas of cellulitis-like involvement are seen, with ulceration common.
• Vasculitis of the larger, deeper vessels can result in a nodular panniculitis. Such a vasculitic process may include lesions of erythema nodosum, erythema induratum, and lupus panniculitis.
• Cold panniculitis. Cold injury to fat tissue can result in a panniculitis.
• Post-steroid panniculitis can occur secondary to the abrupt withdrawal of high dose systemic steroids.
• Idiopathic nodular panniculitis, also known as Weber-Christian disease, is of unknown etiology. Lesions most typical on the lower extremities, but can occur on the trunk. There can be an associated fever, malaise, arthralgia, and myalgia.
• Panniculitis secondary to pancreatic enzyme release. Chronic or acute pancreatitis can release lipolytic enzymes, which can cause fat necrosis.

Treatment:

• Alfa 1 – anti-trypsin deficiency
• A1AT concentrate
• Case report on the benefit of Dapsone and Colchicine
• Liver transplant could be considered in severe cases
• Nodular vasculitis may be treated with non-steroidal anti-inflammatories, potassium iodide, anti-malarials, Colchicine.
• Treat underlying tuberculosis

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