Panniculitis - Causes, Types, Diagnosis and Treatment

What Is Panniculitis?

Our skin has three layers. The first layer is the epidermis, the second layer is the dermis, and the innermost layer is the subcutaneous layer. The subcutaneous layer mainly produces and stores fat. This layer acts as the heat insulator for the body. Panniculitis is an inflammatory condition that can cause single or multiple painful bumps in the subcutaneous layer of the skin.

These bumps can be open ulcerated sores that can lead to inflammation of the subcutaneous layer. The bumps can vary in shape and size. The appearance of panniculitis can differ depending on the cause. In panniculitis, the skin may appear red in affected areas, and it may also cause hardening of the skin.

Panniculitis mainly occurs in the legs and feet. But it can occur in other parts of the body as well. Depending on the site of the inflammation, panniculitis is often classified as lobular panniculitis and septal panniculitis. It can occur if there is some underlying connective tissue disorder, inflammatory disease or may be due to some infections. The diagnosis is made by skin biopsy.

What Causes Panniculitis?

Panniculitis can be due to many reasons, and there are some cases in which panniculitis appears with no significant reason. Such panniculitis is known as idiopathic panniculitis. The different conditions that can lead to panniculitis include:

1. Inflammatory disorders like lipodermatosclerosis, erythema nodosum, etc.

2. Infections (viral and bacterial).

3. Pancreatic disorders.

4. Physical factors like trauma from intense exercise, injecting medicine into the subcutaneous layer, or cold temperature.

5. Connective tissue disorders like systemic lupus erythematosus, systemic sclerosis, etc

6. Alpha-1 antitrypsin deficiency.

7. Lymphoproliferative disorders – A group of diseases with abnormal proliferation of lymphocytes.

8. Drugs like sulfonamide antibiotics.

How Does Panniculitis Look Like?

The appearance of panniculitis can vary depending upon the cause. However, there are some similar symptoms in all types of panniculitis.

Some of them are:

1. Thick and firm nodules under the skin.

2. Red or darker patches on the skin.

3. Painful and tender bumps.

The bumps mainly appear in the legs and feet. It can also appear in the abdominal area, breasts, face, or buttocks. In some cases, tissue around the bumps can get necrosed.

The other systemic symptoms that can accompany panniculitis include:

1. Fever.

2. Fatigue.

3. Nausea and vomiting.

4. Weight loss.

5. Joint and muscle pain.

6. Abdominal pain.

What Are the Different Types of Panniculitis?

Depending upon the site, panniculitis is mainly classified as septal panniculitis and lobular panniculitis. Septal panniculitis may affect the connective tissue around the fat, whereas lobular panniculitis primarily affects the fat lobules.

In some cases, it may also involve the blood vessels causing vasculitis (inflammation of blood vessels).

So it is again classified as:

1. Septal panniculitis with vasculitis.

2. Septal panniculitis without vasculitis.

3. Lobular panniculitis with vasculitis.

4. Lobular panniculitis without vasculitis.

Some forms of panniculitis can also attack the immune cells of the skin like lymphocytes, neutrophils, etc. The most common forms of panniculitis are erythema nodosum (EN) and lipodermatosclerosis (LDS).

EN occurs as tender, hard lumps under the skin. It commonly occurs in women, and it does not form ulcers. It can occur as an allergic reaction due to some infections or drugs.

LDS can lead to the hardening of fat. This condition is seen in the late stages of varicose veins. The LDS is permanent in most cases. Its progression to ulcer can be prevented by the proper treatment. Cold panniculitis is also known as popsicle panniculitis, and it mainly occurs when the skin is exposed to extreme cold. It is common among children. Subcutaneous sarcoidosis is a type of panniculitis that occurs as a side effect of sarcoidosis.

How to Diagnose Panniculitis?

Panniculitis diagnosis includes proper clinical examination, blood tests, skin biopsy, and chest X-ray.

1. Clinical Examination – The physician does a thorough patient examination. The patient’s history and symptoms are well studied.

2. Blood Test – It is mainly done to test the levels of alpha-1 antitrypsin protein.

3. Skin Biopsy – A small tissue sample from the skin is removed and is sent to the lab. The tissue sample is then observed under the microscope for any signs of inflammation.

4. Chest X-ray – It is mainly done in conditions like erythema nodosum.

What Is the Treatment for Panniculitis?

There is no specific treatment for panniculitis. Treatment mainly includes curing the underlying condition that causes panniculitis, thereby bringing down the inflammation. Therefore, treatment can vary in each case.

The medical management of panniculitis include;

1. If panniculitis is caused due to any medications, those medications should be stopped immediately.

2. If panniculitis is caused due to bacterial infections, antibiotics are mainly recommended.

3. Pain relief can be achieved by anti-inflammatory medications like Aspirin, Ibuprofen, etc.

4. Anti-inflammatory drugs like Hydroxychloroquine are given to bring down the inflammation.

5. Oral and injectable systemic steroids are also recommended to bring down the inflammation.

6. Potassium iodide is also recommended, especially in the case of erythema nodosum, to relieve the symptoms. The anti-inflammatory properties of potassium iodide help in the reduction of symptoms.

Compression therapy is also recommended in some cases. It is mainly recommended in panniculitis followed by varicose veins. The compression therapy will force the blood pooled in veins back to the deep vein system, pushing the blood upwards towards the heart, providing some relief to varicose veins, and thereby bringing down the symptoms of panniculitis. Also, some relief can be achieved by taking proper rest and elevating the affected area.

If there are persistent or ulcerated lesions, then surgical removal is needed.

Conclusion:

There are some cases of panniculitis which heal on their own. Most of the patients will require treatment. It may take weeks to months to settle down, and it may recur. Some of them may even leave permanent marks. The cause determines the severity of panniculitis. Proper treatment must be taken at the right time to prevent the progression of the condition.