Lymphedema and Panniculitis
Our Home Page: Lymphedema People
http://www.lymphedemapeople.com
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Lymphedema and Panniculitis
What is panniculitis and why would I have a section on it in a lymphedema website. Very simply, in the skin, most of the lymphatic system is in the subcytaneous tissue and most of the institial fluids that collect as a result of lymphedema are therefire in the subcutaneous tissues.
The subcutaneous tissue is the third of the three layers of skin. The subcutaneous layer contains fat and connective tissue that houses larger blood vessels and nerves. This layer is important is the regulation of temperature of the skin itself and the body. The size of this layer varies throughout the body and from person to person.
Panniculitis is an inflammation of the subcutaneous tissue and can be caused by a number of factors, including lymphedema.
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Panniculitis
Definition of Panniculitis
Panniculitis is an inflammation of the layer of subcutaneous fat underlying the epidermis of the skin. Acute panniculitis is also called nodular fat necrosis.
Causes and Risk Factors of Panniculitis
Panniculitis may result from a variety of conditions. While it is not possible to develop a firm classification of acute panniculitis, one may distinguish between panniculitis without systemic (throughout the body) disease and panniculitis with systemic disease.
Panniculitis without systemic disease is usually due to trauma or a cold. One variant, subcutaneous fat necrosis of the newborn, may be due to a combination of obstetric trauma and hypothermia (low body temperature).
Panniculitis with systemic disease includes collagen vascular disease (lupus and scleroderma), lymphoma, pancreatic cancer and pancreatitis.
Symptoms of Panniculitis
The appearance of single or multiple crops of nodules in subcutaneous fat is the hallmark of acute panniculitis. The nodules are usually, but not always, tender. On occasion, they drain an oily solution and suppuration (pus) may occur. Individual lesions last from one to eight weeks before disappearing, and a pigmented depressed area may be left at the involved site.
While some patients have only nodular panniculitis, which may or may not be relapsing, others may develop fever, abnormal liver function, involvement of the bone marrow, bleeding tendencies, nodular pulmonary lesions and evidence of pancreatic disease. This constellation of findings has been called Weber-Christian disease.
Diagnosis of Panniculitis
Acute panniculitis can be diagnosed only histologically, usually by biopsy of tissue. Once the lesion is identified, a search for the cause must be made. If systemic symptoms are present, the primary differential diagnosis is between collagen vascular disease, lympho-proliferative disorder and pancreatitis or pancreatic cancer.
Treatment of Panniculitis
Treatment is often unsatisfactory. Some physicians may use anti-inflammatory medications. Some patients with certain types of panniculitis may respond to combined chemotherapy with cyclophosphamide, bleomycin and prednisone.
Questions To Ask Your Doctor About Panniculitis
Do any more tests need to be done to diagnose the disease or the cause of the disease?
What is the cause of panniculitis?
What type of treatment will you be recommending?
How effective is this treatment?
Will you be prescribing any medications?
What are the side effects?
http://www.healthscout.com/ency/416/175/main.html
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PANNICULITIS AND DISORDERS OF THE SUBCUTANEOUS FAT
Gerald S. Lazarus
INTRODUCTION. The subcutaneous tissue is a fibrofatty layer spread between skin and muscles. It functions not only as a thermal and mechanical insulator but also as an active metabolic organ. The characteristic signet ring lipocytes are organized into lobules by fibrous septa, which are continuous with the dermis and contain the blood and lymph vessels and reticuloendothelial cells.
The diagnosis of panniculitis frequently requires deep skin biopsy. The most important histologic characteristic is the location of the inflammatory process. Inflammation primarily in the septa is designated septal panniculitis, whereas inflammatory cells primarily in the fat lobules designate lobular panniculitis. The presence or absence of vasculitis further differentiates panniculitis into the four major groups.
LOBULAR PANNICULITIS WITHOUT VASCULITIS
Nodular Panniculitis-Weber-Christian Disease. Nodular panniculitis describes a group of syndromes or diseases characterized by subcutaneous nodules and inflammatory cells in the fat lobules. The term Weber-Christian disease is applied when cutaneous lesions are associated with systemic complaints.
The etiology of this group of diseases is unknown. In the early stages the fat lobules are infiltrated with polymorphonuclear leukocytes. Later, macrophages appear and ingest fat, producing the characteristic lipophagic granuloma. The lesions heal with lobular fibrosis. Modest septal vasculitis may be observed. Lobular panniculitis most commonly presents in females between the ages of 30 and 60, although cases have been reported in all age groups. The lesions begin as red, slightly tender nodules deep in the skin. They appear more or less in symmetric crops on thighs and lower legs, but lesions may also occur on arms, trunk, and face. The number of lesions may vary enormously. The lesions become firmer, less red, and less tender over a period of weeks. They heal, leaving a depressed hyperpigmented scar. Liquefying panniculitis is a variant in which the lesions become necrotic and drain an oily, yellow-brown fluid. Rothmann-Makai syndrome is a very rare variant of lobular parmiculitis, affecting children with numerous large lesions; the lesions do not liquefy, and healing usually occurs within 12 months.
Systemic nodular parmiculitis or Weber-Christian disease is a widespread proces~ affecting cutaneous and visceral fat. Patients usually present with unequivocal cutaneous nodules and arthralgias, malaise, fatigue, weight loss, and abdominal pain. Involvement of the bone marrow may produce anemia, leukocytosis or leukopenia, and bone pain. Hepatomegaly, steatorrhea, and intestinal perforation have also been reported. Inflammation may occur in other internal organs such as lungs, pleura, pericardium, spleen, kidney, and adrenal glands. Visceral involvement may be confined to the retroperitoneal space, producing abdominal pain, nausea, and vomiting. Alpha,-antitrypsin deficiency is associated with this syndrome not infrequently. Malignant histiocytosis (cytophagic histiocytic panniculitis) may present as Weber-Christian disease. The prognosis of nodular panniculitis is good in patients with only cutaneous involvement. There are frequent remissions and exacerbations of the lesions. Some patients recover after a few months, and permanent remission is usual after several years. On rare occasions visceral involvement may be fatal.
There is no specific therapy for this disease. Saturated potassium iodide, increasing from 5 drops three times daily by 1 drop per day to 30 drops three times daily, has been suggested. Hydroxychloroquine,* 200 mg twice per day, has also been advocated as treatment. High dose prednisone, 40 to 60 mg for one to two weeks with gradual tapering over six to eight weeks, has also been reported to be of value in patients with severe disease; steroids should be used only for acute attacks and for limited periods of time.
Lobular Panniculitis Associated with Pancreatic Disease. The diagnosis is made by skin biopsy, which discloses acute fat necrosis with characteristic ghost cells. These patients often have associated arthritis, ascites, and eosinophilia. Acute pancreatitis, trauma to the pancreas, chronic pancreatitis, pancreatic cysts, and pancreatic carcinoma have been reported to be associated with this syndrome. Diagnosis depends upon the histologic findings at skin biopsy and documentation of a specific pancreatic abnormality. Therapy is directed at the underlying pancreatic disease.
Poststeroid Lobular Panniculitis. Children who receive large doses of steroid for a short period of time, followed by abrupt discontinuance, may develop lobular parmiculitis. Lesions may occur in the viscera, and a fatal case has been reported. Physical Lobular Panniculitis. Physical trauma of any kind and cold injury, especially in children, can produce lobular panniculitis. A unique traumatic panniculitis occurs in the obese breasts of women in their 50's. Injection of silicones or other foreign materials into female breasts or buttocks and into the male genitalia may induce a granulomatous foreign body nodular panniculitis. Similar inflammatory lesions may be seen following injections of Talwin.
Lobular Panniculitis Associated with Systemic Disease. Lupus erythematosus, sarcoidosis, granuloma annulare, Sweet's disease, acute sudden weight loss from gastrointestinal surgery, and infections including deep fungi and pyogens may present as lobular parmiculitis. Lymphoma or leukemia may also present as panniculitis; histologically, these lesions demonstrate malignant cells in the fat lobules. Lupus erythematosus confined primarily to the fat is known as lupus profundus. The skin may be exclusively involved, or the panniculitis may be associated with systemic disease.
LOBULAR PANNICULITIS WITH VASCULITIS.
This category of disease includes nodular vasculitis and erythema induratum. The eruption consists of recurring, tender, painful nodules on the calves, which often ulcerate and heal with scarring. It is much more common in females than in males. Increased erythrocyte sedimentation rate and hypertension have been associated with this syndrome. Bazin gave the name erythema induraturn to this disease when histologic examination revealed caseation necrosis and the lesions were associated with tuberculosis. There is no specific therapy. Most patients have remission of lesions with bed rest. Severe cases have been successfully treated with nonsteroidal anti-inflammatory drugs, dapsone, and prednisone. In the very rare case of nodular vasculitis associated with tuberculosis, appropriate antituberculous therapy is indicated.
SEPTAL PANNICULITIS WITHOUT VASCULITI
This histology in a patient with nodular, painful, tender lesions, especially on the anterior leg, is diagnostic of erythema nodosum, which is discussed in Ch. 534. A chronic disease similar to erythema nodosum clinically and histologically except that the lesions spread peripherally over months, forming rings, is called subacute migratory panniculitis. This disease responds to therapy with increasing doses of saturated *This use is not listed in the manufacturer's directive.
potassium iodide as described for nodular panniculitis. Septal parmiculitis without vasculitis can also be seen in scleroderma, eosinophilic fasciitis, dermatomyositis, and necrobiosis lipoidica diabeticorum.
SEPTAL PANNICULITIS WITH VASCULITIS
Thrombophlebitis may present with subcutaneous nodules. Histology reveals inflammation of veins with adjacent parmiculitis (see Ch. 57). Cutaneous polyarteritis is a chronic, recurring, painful nodular eruption, primarily of the legs. There is often an associated mottled livedo vascular pattern. Cutaneous polyarteritis is associated with myalgias, arthralgias, and increased erythrocyte sedimentation rate. Histologic examination demonstrates leukocytoclastic vasculitis of medium-sized arterioles. This disease is usually not associated with systemic involvement. It has a benign course, but lesions may recur for years. Therapy includes nonsteroidal anti-inflammatory agents and short courses of corticosteroids. Cutaneous polyarteritis associated with granulornatous bowel disease has responded to short courses of Cytoxan.
LIPOATROPHY
Loss of subcutaneous tissue can occur as a consequence of healing in almost any of the parmiculitides described previously. The most common diagnosable cause of lipoatrophy is recurrent insulin injection. Insulin lipoatrophy is usually associated with repetitive injections of high doses of insulin in exactly the same location in females. Talwin injections may also produce panniculitis and severe lipoatrophy.
Total lipoatrophy associated with diabetes may occur in children and adults. The clinical picture is dramatic, and there is almost complete loss of subcutaneous fat. Partial lipoatrophy usually begins in children or young adults. It is five times more common in females than in males. Patients often lose the fat in the face and the upper half of the body. In some cases, there is hypertrophy of the fat on the lower half of the body. Patients with partial lipodystrophy often develop progressive mesangiocapillary glomerulonephritis and hypocomplementernia. Diabetes develops in one third of these patients. Retinitis pigmentosum has also been reported with this disease. The prognosis depends upon the severity of the renal disease
http://www.geocities.com/SoHo/Gallery/6 ... ulitis.htm
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Erythema Nodosum Support Group
http://health.groups.yahoo.com/group/er ... sum_Group/
The website for the group Is
Erythema Nodosum
http://www.geocities.com/erythema_nodos ... _Page.html
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Panniculitis at Yahoo Groups
http://health.groups.yahoo.com/group/panniculitis/
Subscribe: panniculitis-subscribe@yahoogroups.com
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For Further Information
Subacute Nodular Migratory Panniculitis (Vilanova Disease)
eMedicine
Last Updated: July 28, 2003
Synonyms and related keywords: chronic erythema nodosum, erythema nodosum migrans
Author: Sarah M Boyce, MD, Staff Physician, Department of Dermatology, University of Alabama School of Medicine
Coauthor(s): Daniel Davis, MD, Program Director, Assistant Professor, Departments of Dermatology and Pathology, University of Alabama at Birmingham School of Medicine
http://www.emedicine.com/derm/topic408.htm
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Cold Panniculitis
eMedicine
Last Updated: November 29, 2001
Author: Geromanta Baleviciene, MD, Head, Professor, Department of Dermatology, Vilnius University, Medical Faculty, Lithuania
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Richard J Cervin, MD, Consulting Staff, Department of Dermatology, Baltic-American Medical and Surgical Clinic, Lithuania
http://www.emedicine.com/derm/topic781.htm
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Panniculitis, Idiopathic Nodular
http://my.webmd.com/hw/health_guide_atoz/nord297.asp
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Related Links Page for Pub Med / National Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/quer ... id=9674398
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PANNICULITIS
HELLENIC ASSOCIATION DERMATOLOGY - VENEREOLOGY
Links to Articles
http://www.edae.gr/panniculitis.html
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ERYTHEMA NODOSUM PANNICULITIS
eMedicine
Last Updated: April 12, 2002
Synonyms and related keywords: EN, delayed hypersensitivity reaction
Author: Jeanette Hebel Matthews, MD, Department of Dermatology, The Skin Surgery Center
Coauthor(s): Thomas Habif, MD, Adjunct Professor, Department of Internal Medicine, Section of Dermatology, Dartmouth Medical School
http://www.emedicine.com/derm/topic138.htm
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ERYTHEMA NODOSUM PANNICULITIS
Medline Plus
http://www.nlm.nih.gov/medlineplus/ency ... 000881.htm
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Panniculitis - Diagnostic Images
Atlas of Dermatology
http://atlases.muni.cz/atl_en/main nenadory pann.html
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Panniculitis - Diagnostic Images
Dermatlas
http://dermatlas.med.jhmi.edu/derm/resu ... -639418194
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Panniculitis - Diagnostic Images
Google
http://images.google.com/images?q=panni ... rt=20&sa=N
Yahoo
http://images.search.yahoo.com/search/i ... 1&ei=UTF-8
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Panniculitis
Panniculitis refers to a group of conditions that involve inflammation of the fat under the skin. Despite having very diverse causes, most forms of panniculitis have the same clinical appearance. The diagnosis is established by a skin biopsy as there are characteristic microscopic features depending on the cause.
The classification of panniculitis is complicated but, in general, different types can be divided into mostly septal or mostly lobular panniculitis depending on where the microscopic inflammation is most concentrated. In reality, most types of panniculitis have both lobular and septal inflammation. Further classification is based on whether or not there is inflammation involving the blood vessels of the fat, i.e. vasculitis.
Classification of panniculitis
Mostly septal panniculitis with vasculitis
Leukocytoclastic vasculitis
Superficial thrombophlebitis
Cutaneous polyarteritis nodosa
Mostly septal panniculitis without vasculitis
Necrobiosis lipoidica
Scleroderma, which may be localised (morphoea)
Subcutaneous granuloma annulare
Rheumatoid nodule
Necrobiotic xanthogranuloma
Erythema nodosum
Mostly lobular panniculitis with vasculitis
Erythema nodosum leprosum (leprosy)
Lucio's phenomenon
Neutrophilic lobular panniculitis associated with rheumatoid arthritis
Erythema induratum of Bazin
Crohn's disease
Mostly lobular panniculitis without vasculitis
Sclerosing panniculitis (lipodermatosclerosis)
Calciphylaxis
Oxalosis
Sclerema neonatorum
Cold panniculitis
Lupus panniculitis
Panniculitis in dermatomyositis
Pancreatic panniculitis
Alpha-1 antitrypsin deficiency
Infective panniculitis
Factitial panniculitis
Subcutaneous sarcoidosis
Traumatic panniculitis
Lipoatrophy
Subcutaneous fat necrosis of the newborn
Post-steroid panniculitis
Gout panniculitis
Crystal-storing panniculitis
Cytophagic histiocytic panniculitis
Post-irradiation pseudosclerodermatous panniculitis
Clinical Features
An area of skin involved with panniculitis feels thickened and woody to touch. It may or may not demonstrate discolouration of the overlying skin, either reddening or darker, brownish pigmentation. The area is often tender. Most often, the affected areas appear as raised nodules or lumps under the skin, but may be a plaque or large flat area of thickened skin.
Treatment
Treatment includes:
Treat the underlying cause, if known (e.g. stop a medication, treat an infection)
Rest and elevate the affected area
Compression hosiery (18-25mm Hg pressure) if these can be tolerated
Pain relief using anti-inflammatory medications such as aspirin, ibuprofen or diclofenac
Systemic steroids (oral or injected) to settle the inflammation
Anti-inflammatory antibiotics including tetracycline or hydroxychloroquine
Potassium iodide
Surgical removal of persistent or ulcerated lesions.
http://dermnetnz.org/dermal-infiltrativ ... litis.html
Related topics
On DermNet:
Erythema nodosum
Necrobiosis lipoidica
Morphoea (localised scleroderma)
www.dermnetnz.org/
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Weber-Christian panniculitis: a review of 30 cases with this diagnosis.
White JW Jr, Winkelmann RK.
Department of Dermatology, Mayo Clinic Jacksonville, Florida 32224, USA.
BACKGROUND:
More than 60 years ago, Christian described a panniculitis that was later termed Weber-Christian disease. OBJECTIVE: The purpose of this study was to investigate whether this is a specific disease or a nonspecific disease that embraces several specific conditions.
METHODS:
We studied 30 cases diagnosed as Weber-Christian panniculitis and found it possible to make a more specific diagnosis. RESULTS: In 12 patients, findings were compatible with erythema nodosum. Six patients had phlebitis or postphlebitic syndrome. Factitial panniculitis was diagnosed in five patients, and trauma had a role in the conditions of another three patients. Cytophagic panniculitis, lymphoma, and leukemia were recognized in one patient each. The lesion was lobular in almost all cases, and the presence of lipophagia was noted in 19 biopsy specimens. Granulomatous, neutrophilic, and lymphocytic pathologic changes were present in nine, eight, and eight tissue specimens, respectively.
CONCLUSION:
The recognition of distinct disease patterns of fat lesions as fat necrosis with pancreatic disease, alpha1-antitrypsin panniculitis, lupus and connective tissue disease panniculitis, involution lipoatrophy, lipomembranous panniculitis, factitial panniculitis syndromes, calcification panniculitis, lipophagic lipoatrophy, and cytophagic panniculitis has lessened the need for a less specific panniculitis category. All these diseases have been reported in the literature as "Weber-Christian disease." Because separate and distinct forms of fat lesions have been described, we believe that the eponym should be abandoned and that more specific diagnoses should be made on the basis of pathogenesis or cause.
MeSH Terms:
Adult
Aged
Diagnosis, Differential
Erythema Nodosum/diagnosis
Factitious Disorders/diagnosis
Fat Necrosis/diagnosis
Fat Necrosis/pathology
Female
Granuloma/pathology
Humans
Leukemia/diagnosis
Lymphocytes/pathology
Lymphoma/diagnosis
Male
Middle Aged
Neutrophils/pathology
Panniculitis/classification
Panniculitis/diagnosis
Panniculitis/pathology
Panniculitis, Nodular Nonsuppurative/diagnosis*
Panniculitis, Nodular Nonsuppurative/pathology
Panniculitis, Nodular Nonsuppurative/psychology
Phlebitis/diagnosis
Postphlebitic Syndrome/diagnosis
Skin/injuries
Skin Neoplasms/diagnosis
PMID: 9674398 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Citation
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Mesenteric Panniculitis
http://brighamrad.harvard.edu/Cases/bwh ... /full.html
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Sclerosing panniculitis
Lipomembranous (Membranocystic) Fat Necrosis: Clinicopathologic Correlation of 38 Cases.
http://www.amjdermatopathology.com/pt/r ... -00007.htm jsessionid=CVqYN16lrvE2iQJVU3MYRAZdBpA2rpStujIiO7OZ9rGbNVSfF2Iv!884695698!-949856031!9001!-1
I wanted to share about two great resources I just learned about for Panniculitis.
This website and Yahoo support group focuses on Erythema Nodosum, which is a form of panniculitis.
The online support group is:
Erythema Nodosum Support Group
http://health.groups.yahoo.com/group/er ... sum_Group/
The website for the group Is
Erythema Nodosum
http://www.geocities.com/erythema_nodos ... _Page.html