Panniculitis

==Signs and symptoms==

==Signs and symptoms==

Panniculitis can also be classified based on the presence or absence of systemic [[symptoms]]. Panniculitis without systemic disease can be a result of [[Physical trauma|trauma]] or cold.<ref name="titleeMedicine - Cold Panniculitis : Article by Geromanta Baleviciene">{{cite web |url=http://www.emedicine.com/derm/topic781.htm |title=eMedicine - Cold Panniculitis: Article by Geromanta Baleviciene |access-date=2008-03-25 }}</ref> Panniculitis with systemic disease can be caused by{{Citation needed|date=February 2018}}:

Panniculitis can also be classified based on the presence or absence of systemic [[symptoms]]. Panniculitis without systemic disease can be a result of [[Physical trauma|trauma]] or cold.<ref name="titleeMedicine - Cold Panniculitis: Article by Geromanta Baleviciene">{{cite web |url=http://www.emedicine.com/derm/topic781.htm |title=eMedicine - Cold Panniculitis: Article by Geromanta Baleviciene |access-date=2008-03-25 }}</ref> Panniculitis with systemic disease can be caused by{{Citation needed|date=February 2018}}:

* [[connective tissue]] disorders such as [[lupus erythematosus]] or [[scleroderma]];

* [[connective tissue]] disorders such as [[lupus erythematosus]] or [[scleroderma]];

* [[lymphoproliferative]] disease such as [[lymphoma]] or [[histiocytosis]];

* [[lymphoproliferative]] disease such as [[lymphoma]] or [[histiocytosis]];

==Diagnosis==

==Diagnosis==

===Classification===

===Classification===

It can occur in any fatty tissue ([[cutaneous]] or visceral) and is often diagnosed on the basis of a deep skin [[biopsy]], and can be further classified by [[histological]] characteristics based on the location of the inflammatory cells (within fatty lobules or in the septa which separate them) and on the presence or absence of [[vasculitis]].{{citation needed|date=September 2021}}

It can occur in any fatty tissue ([[cutaneous]] or visceral) and is often diagnosed based on a deep skin [[biopsy]], and can be further classified by [[histological]] characteristics based on the location of the inflammatory cells (within fatty lobules or in the septa which separate them) and on the presence or absence of [[vasculitis]].{{citation needed|date=September 2021}}

There are thus four main histological subtypes:<ref name="urlPanniculitis. DermNet NZ">{{cite web |url=http://dermnetnz.org/dermal-infiltrative/panniculitis.html |title=Panniculitis. DermNet NZ |access-date=2010-05-17}}</ref>

There are thus four main histological subtypes:<ref name="urlPanniculitis. DermNet NZ">{{cite web |url=http://dermnetnz.org/dermal-infiltrative/panniculitis.html |title=Panniculitis. DermNet NZ |access-date=2010-05-17}}</ref>

# lobular panniculitis without vasculitis (acute panniculitis, previously termed [[Weber–Christian disease]],<ref name="titleeMedicine - Weber-Christian Disease : Article by Moise L Levy">{{cite web |url=http://www.emedicine.com/ped/topic2429.htm |title=eMedicine - Weber-Christian Disease: Article by Moise L Levy |access-date=2008-03-25 }}</ref> systemic nodular panniculitis)

# lobular panniculitis without vasculitis (acute panniculitis, previously termed [[Weber–Christian disease]],<ref name="titleeMedicine - Weber-Christian Disease: Article by Moise L Levy">{{cite web |url=http://www.emedicine.com/ped/topic2429.htm |title=eMedicine - Weber-Christian Disease: Article by Moise L Levy |access-date=2008-03-25 }}</ref> systemic nodular panniculitis)

# lobular panniculitis with vasculitis

# lobular panniculitis with vasculitis

# septal panniculitis without vasculitis

# septal panniculitis without vasculitis

[[Erythema induratum]], or "Bazin disease", is a panniculitis on the back of the calves.<ref>{{DorlandsDict|three/000036706|erythema induratum}}{{Dead link |date=June 2011 }}</ref> It was formerly thought to be a reaction to the [[tuberculum bacillus]]. It is now considered a panniculitis that is not associated with a single defined pathogen.<ref name="isbn0-7216-0187-1">{{cite book |author1=Cotran, Ramzi S. |author2=Kumar, Vinay |author3=Fausto, Nelson |author4=Nelso Fausto |author5=Robbins, Stanley L. |author6=Abbas, Abul K. |title=Robbins and Cotran pathologic basis of disease |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2005 |pages=1265 |isbn=978-0-7216-0187-8 |edition=7th}}</ref>

[[Erythema induratum]], or "Bazin disease", is a panniculitis on the back of the calves.<ref>{{DorlandsDict|three/000036706|erythema induratum}}{{Dead link |date=June 2011 }}</ref> It was formerly thought to be a reaction to the [[tuberculum bacillus]]. It is now considered a panniculitis that is not associated with a single defined pathogen.<ref name="isbn0-7216-0187-1">{{cite book |author1=Cotran, Ramzi S. |author2=Kumar, Vinay |author3=Fausto, Nelson |author4=Nelso Fausto |author5=Robbins, Stanley L. |author6=Abbas, Abul K. |title=Robbins and Cotran pathologic basis of disease |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2005 |pages=1265 |isbn=978-0-7216-0187-8 |edition=7th}}</ref>

[[Nodular vasculitis]] is a skin condition characterized by small, tender, reddened nodules on the legs, mostly on the calves and shins. Microscopically there are epithelioid granulomas and vasculitis in the subcutaneous tissue, making it a form of panniculitis. Most of these cases are now thought to be manifestation of tuberculosis and indeed they respond well to anti-tuberculous treatment.{{Citation needed|date=June 2010}}

[[Nodular vasculitis]] is a skin condition characterized by small, tender, reddened nodules on the legs, mostly on the calves and shins. Microscopically, there are epithelioid granulomas and vasculitis in the subcutaneous tissue, making it a form of panniculitis. Most of these cases are now thought to be manifestations of tuberculosis, and indeed they respond well to anti-tuberculous treatment.{{Citation needed|date=June 2010}}

=====Without vasculitis=====

=====Without vasculitis=====

Non-vasculitis forms of panniculitis that may occur include:

Non-vasculitis forms of panniculitis that may occur include:

* ''Cytophagic histiocytic panniculitis'' was first described in 1980 by Winkelmann as a chronic [[histiocytic]] disease of the [[Subcutaneous tissue|subcutaneous]] [[adipose tissue]], which is characterized clinically by tender [[erythematous]] [[Nodule (medicine)|nodules]], recurrent high [[fever]], [[malaise]], [[jaundice]], [[organomegaly]], [[serosal]] effusions, [[pancytopenia]], [[hepatic]] dysfunction and [[coagulation]] abnormalities.<ref name="ANDREWS2006"/>{{rp|494}}<ref>Winkelmann RK, Bowie EJ. Hemorrhagic diathesis associated with benign histiocytic cytophagic panniculitis and systemic histiocytosis. ''Arch Intern Med''.1980; 140: 1460-3</ref> CHP may occur either isolated or as part of cutaneous manifestations of [[hemophagocytic syndrome]] (HPS).<ref>Smith K J, Skeleton H J, Yeagre J, Angritt P, Wagner K, James W. D., Giblin W. J., Lupton G. P. Cutaneous histopathological, immunohistochemical, and clinical manifestations inpatients with hemophagocytic syndrome. Military Medical old Consortium for Applied Retroviral Research (MMCARR). ''Arch Dermatol'' 1992; 128: 193-200</ref> CHP is a rare and often fatal form of panniculitis with multisystem involvement. But it can also present in a benign form involving only the subcutaneous tissue, thus having a broad clinical spectrum.

* ''Cytophagic histiocytic panniculitis'' was first described in 1980 by Winkelmann as a chronic [[histiocytic]] disease of the [[Subcutaneous tissue|subcutaneous]] [[adipose tissue]], which is characterized clinically by tender [[erythematous]] [[Nodule (medicine)|nodules]], recurrent high [[fever]], [[malaise]], [[jaundice]], [[organomegaly]], [[serosal]] effusions, [[pancytopenia]], [[hepatic]] dysfunction and [[coagulation]] abnormalities.<ref name="ANDREWS2006"/>{{rp|494}}<ref>Winkelmann RK, Bowie EJ. Hemorrhagic diathesis associated with benign histiocytic cytophagic panniculitis and systemic histiocytosis. ''Arch Intern Med''.1980; 140: 1460-3</ref> CHP may occur either isolated or as part of cutaneous manifestations of [[hemophagocytic syndrome]] (HPS).<ref>Smith K J, Skeleton H J, Yeagre J, Angritt P, Wagner K, James W. D., Giblin W. J., Lupton G. P. Cutaneous histopathological, immunohistochemical, and clinical manifestations in patients with hemophagocytic syndrome. Military Medical Old Consortium for Applied Retroviral Research (MMCARR). ''Arch Dermatol'' 1992; 128: 193-200</ref> CHP is a rare and often fatal form of panniculitis with multisystem involvement. But it can also present in a benign form involving only the subcutaneous tissue, thus having a broad clinical spectrum.

* ''Traumatic panniculitis'' is a panniculitis that occurs following trauma to the skin.<ref name=ANDREWS2006 />{{rp|492}}<ref name=BOLOGNIA2007>{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=1515 |isbn=978-1-4160-2999-1 }}</ref>

* ''Traumatic panniculitis'' is a panniculitis that occurs following trauma to the skin.<ref name=ANDREWS2006 />{{rp|492}}<ref name=BOLOGNIA2007>{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=1515 |isbn=978-1-4160-2999-1 }}</ref>

* ''Cold panniculitis'' is a panniculitis occurring after exposure to cold, most often seen in infants and young children.<ref name=ANDREWS2006 />{{rp|491}} This condition has been described in children who suck ice or [[ice pop|popsicle]]s, and therefore is sometimes referred to as "popsicle panniculitis."<ref name="ANDREWS2006"/>{{rp|491}}<ref name=BOLOGNIA2007 /> The term was coined when a patient with a rash of unknown origin on her cheek was taken to a [[dermatologist]].<ref>Epstein, Ervin and Oren, Mark, [http://www.nejm.org/doi/full/10.1056/NEJM197004232821709 "Popsicle Panniculitis"] "The New England Journal of Medicine", 282 (17) : 966-67, 1970</ref>

* ''Cold panniculitis'' is a panniculitis occurring after exposure to cold, most often seen in infants and young children.<ref name=ANDREWS2006 />{{rp|491}} This condition has been described in children who suck ice or [[ice pop|popsicle]]s, and therefore is sometimes referred to as "popsicle panniculitis."<ref name="ANDREWS2006"/>{{rp|491}}<ref name=BOLOGNIA2007 /> The term was coined when a patient with a rash of unknown origin on her cheek was taken to a [[dermatologist]].<ref>Epstein, Ervin and Oren, Mark, [http://www.nejm.org/doi/full/10.1056/NEJM197004232821709 "Popsicle Panniculitis"] "The New England Journal of Medicine", 282 (17): 966-67, 1970</ref>

* ''Gouty panniculitis'' is a panniculitis caused by deposition of [[uric acid]] crystals in [[gout]].<ref name=ANDREWS2006 />{{rp|494}}

* ''Gouty panniculitis'' is a panniculitis caused by deposition of [[uric acid]] crystals in [[gout]].<ref name=ANDREWS2006 />{{rp|494}}

* ''Pancreatic panniculitis'' (also known as enzymatic panniculitis, Pancreatic fat necrosis,<ref name= BOLOGNIA2007 /> and subcutaneous fat necrosis) is a panniculitis most commonly associated with [[pancreatic carcinoma]], and more rarely with anatomic pancreatic abnormalities, [[pseudocyst]]s, or drug-induced pancreatitis.<ref name=ANDREWS2006 />{{rp|493}}

* ''Pancreatic panniculitis'' (also known as enzymatic panniculitis, Pancreatic fat necrosis,<ref name= BOLOGNIA2007 /> and subcutaneous fat necrosis) is a panniculitis most commonly associated with [[pancreatic carcinoma]], and more rarely with anatomic pancreatic abnormalities, [[pseudocyst]]s, or drug-induced pancreatitis.<ref name=ANDREWS2006 />{{rp|493}}

* [[Weber–Christian disease]], a symmetrical form of the disease of unknown origin occurring in middle-aged women.<ref name=ANDREWS2006 />{{rp|492}}

* [[Weber–Christian disease]], a symmetrical form of the disease of unknown origin occurring in middle-aged women.<ref name=ANDREWS2006 />{{rp|492}}

* [[Lupus erythematosus panniculitis]], panniculitis associated with [[lupus erythematosus]].<ref name=BOLOGNIA2005 />

* [[Lupus erythematosus panniculitis]], panniculitis associated with [[lupus erythematosus]].<ref name=BOLOGNIA2005 />

* Forms associated with use of high doses of systemic corticosteroids during rapid corticosteroid withdrawal, and from the injection of [[silicone]] or [[mineral oil]]s.<ref name=ANDREWS2006 />{{rp|492}}<ref>{{Cite journal | url=https://www.ijpd.in/text.asp?2022/23/2/165/341455 | title=Poststeroid panniculitis – A rare case report | journal=Indian Journal of Paediatric Dermatology | date=April 2022 | volume=23 | issue=2 | page=165 | last1=Garg | first1=Taru | last2=Ahmed | first2=Riaz | last3=Bharadwaj | first3=Apoorva V. | last4=Shukla | first4=Shailaja | doi=10.4103/ijpd.ijpd_116_21 | doi-access=free }}</ref>

* Forms associated with the use of high doses of systemic corticosteroids during rapid corticosteroid withdrawal, and from the injection of [[silicone]] or [[mineral oil]]s.<ref name=ANDREWS2006 />{{rp|492}}<ref>{{Cite journal | url=https://www.ijpd.in/text.asp?2022/23/2/165/341455 | title=Poststeroid panniculitis – A rare case report | journal=Indian Journal of Paediatric Dermatology | date=April 2022 | volume=23 | issue=2 | page=165 | last1=Garg | first1=Taru | last2=Ahmed | first2=Riaz | last3=Bharadwaj | first3=Apoorva V. | last4=Shukla | first4=Shailaja | doi=10.4103/ijpd.ijpd_116_21 | doi-access=free }}</ref>

====Septal====

====Septal====

=====Erythema nodosum=====

=====Erythema nodosum=====

{{Main|Erythema nodosum}}

{{Main|Erythema nodosum}}

Erythema nodosum is a form of panniculitis characterised by tender red nodules, 1–10&nbsp;cm, associated with systemic symptoms including fever, malaise, and joint pain. Nodules may become bluish-purple, yellowing, and green, and subside over a period of 2–6 weeks without ulcerating or scarring. Erythema nodosum is associated with [[infection]]s, including [[Hepatitis C]], [[Infectious mononucleosis|EBV]] and [[tuberculosis]], [[Crohn's disease]] and [[sarcoidosis]], [[pregnancy]], medications including [[sulfonamide (medicine)|sulfonamides]], and some [[cancer]]s, including [[Non-Hodgkin lymphoma]] and [[pancreatic cancer]].<ref name=GILCHRIST2010>{{cite journal|last=Gilchrist|first=H|author2=Patterson, JW|title=Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management.|journal=Dermatologic Therapy|date=Jul–Aug 2010|volume=23|issue=4|pages=320–7|pmid=20666819|doi=10.1111/j.1529-8019.2010.01332.x|s2cid=39695627|doi-access=free}}</ref>

Erythema nodosum is a form of panniculitis characterised by tender red nodules, 1–10&nbsp;cm, associated with systemic symptoms including fever, malaise, and joint pain. Nodules may become bluish-purple, yellowing, and green, and subside over 2–6 weeks without ulcerating or scarring. Erythema nodosum is associated with [[infection]]s, including [[Hepatitis C]], [[Infectious mononucleosis|EBV]] and [[tuberculosis]], [[Crohn's disease]] and [[sarcoidosis]], [[pregnancy]], medications including [[sulfonamide (medicine)|sulfonamides]], and some [[cancer]]s, including [[Non-Hodgkin lymphoma]] and [[pancreatic cancer]].<ref name=GILCHRIST2010>{{cite journal|last=Gilchrist|first=H|author2=Patterson, JW|title=Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management.|journal=Dermatologic Therapy|date=Jul–Aug 2010|volume=23|issue=4|pages=320–7|pmid=20666819|doi=10.1111/j.1529-8019.2010.01332.x|s2cid=39695627|doi-access=free}}</ref>

=====A1AT-deficiency-associated=====

=====A1AT-deficiency-associated=====