Panniculitis

What is Panniculitis?

A layer of fat found under the skin is called the subcutaneous fat layer or panniculus. The layer consists of lobules (groups of fat cells) that are held together by connective tissues. They help to regulate the temperature of the body and acts as a layer of insulation. A condition, in which nodules or painful bumps and patches are formed under the skin in the panniculus, it is known as panniculitis. It may include inflammation under the skin, especially on the legs and the feet.

People suffering from connective tissue disorders, infections or inflammations are more vulnerable to panniculitis. Young or middle aged women are more likely to develop such a condition. Moreover, there are different types of panniculitis that people may be suffering from depending upon the area of fat where the inflammation has occurred.

Image Source – Wikimedia

Types of Panniculitis

Septal panniculitis	Affects the connective tissues around the fat
Lobular panniculitis	Affects the fat lobules
Vasculitis	Inflamed blood vessels
Erythema nodosum	Painful red lumps occur on the front of the lower legs accompanied by headaches, fever & eye problems
Lipodermatosclerosis	Commonly affects women above the age of 40 years & those who are overweight. It is associated with obesity & problems related to the veins
Cold panniculitis	Affects areas of the skin that have been exposed to extreme cold, such as frozen teething rings in children
Subcutaneous sarcoidosis	Occurs as an effect of sarcoidosis disease
Erythema induratum	Middle aged women are affected around the calf area
Weber Christian disease	Causes bumps on various organs, as well as on lower legs and thighs, especially in middle aged women

Panniculitis affects different types of Immune Cells on the Skin:

• Histiocytes
• Neutrophils
• Granulomas
• Lymphocytes

Causes of Panniculitis

• Medicines: Corticosteroids in large quantities, bromide, iodine, sulfonamide antibiotics, etc. are some medications whose intake may cause panniculitis.
• Sarcoidosis: Condition which involves the formation of clumps of inflammatory cells in the body.
• Infections: Bacterial infections such as streptococcus tuberculosis as well as those infections caused by parasites, fungi or virus.
• Injuries: Injuries while exercising or the skin being exposed to extremely cold temperature or when medicines are injected into the fat layer below the skin
• Inflammatory diseases: May occur in people who suffer from ulcerative colitis or Corhn’s disease
• Diabetes: Painful red bumps may occur under the skin of diabetic people
• Cancers: People suffering from lymphoma and leukemia are also prone to panniculitis
• Connective tissue disorders: Rheumatoid arthritis, scleroderma and lupus are disorders associated with the connective tissues
• Pancreatic diseases: Problems in the pancreas may also result in formation of red bumps in the fat layer
• Deficiency: Lung and liver diseases are caused due to a genetic disorder known as alpha-1 antitrypsin deficiency, it also causes panniculitis

Symptoms of Panniculitis

• Weight loss
• Fatigue
• Nausea
• Vomiting
• Abdominal pain
• General sick feeling
• Muscle pain
• Joint pain
• Fever
• Bulging eyes
• Tender and painful bumps known as nodules
• Oily substance may drain from the nodules
• Nodules may vary in size
• Skin over the bumps becomes discolored
• Necrosis (break down of tissues around the large and deep bumps on the skin)
• Bumps usually appear on the legs, feet, chest, buttocks, face, abdomen & arms of the individual, where more fatty tissues are found
• Bumps may fade and reoccur over time
• Skin may be left with a groove or indentation after the bumps have faded
• Sings of damage in the liver, pancreas, lungs or bone marrow
• Skin may have a woody feeling on being touched due to its thickening
• Lumps may be raised up to a few mm
• Red or dark brown pigmentation of the skin

Tests for Panniculitis

• Examination of skin
• Enquiry about the medical history
• Biopsy of the skin from the affected area
• To check for bacterial infection a throat swab might be used
• To check the levels of protein alpha-1 antitrypsin, a blood test may be taken
• CT scan
• Chest X-ray
• To check the level of inflammation of the body a erythrocyte sedimentation rate blood test can be conducted

Panniculitis Treatment

• Rest: In most cases bed rest is prescribed to people in order to ensure that they do not aggravate the condition of the affected area. Moreover, it is also advised that people must keep their legs elevated in order to aid the healing process.
• Medication: A number of medications can be given to the individuals suffering from panniculitis to reduce the inflammation, pain or to help in healing the infection, such as aspirin, ibuprofen, hydroxychloroquine, tetracycline, potassium, iodine, etc.
• Withdrawal: There are some medications that induce panniculitis. A physician must be consulted in order to prescribe alternatives and gradually withdraw from the intake of these medicines.
• Time: Certain conditions of panniculitis are caused due to sarcoidosis, which do not need treatment. They gradually heal on their own with time.
• Additional items: The use of bandages or wearing compression stockings can also help in reducing the inflammation of the lumps on the skin.
• Surgery: In certain extreme cases where the condition cannot be controlled or reversed with treatment, the infection is surgically removed. However, certain criteria must be fulfilled in order to undergo a surgery. The patient must be made aware of the possible complications related to the surgery such as post surgical infections.

When to visit a doctor?

As mentioned above, some forms of panniculitis can heal over time. However, in some people this condition reoccurs from time to time. The condition must be taken seriously the moment these symptoms become extreme and unbearable. Medical expertise is required in order to rule out any other serious underlying health condition. It is always good to be well informed with regard to the effectiveness of the treatment undertaken, possible side effects of the medications prescribed, the cause of the panniculitis, etc.

Panniculitis Pictures