What Is Panniculitis?

It is more complicated. Local factors such as trauma, cold, injection of certain drugs, systemic factors such as tuberculosis infection, tonsillitis, etc. can cause panniculitis, and some systemic diseases such as lupus erythematosus, scleroderma, and sarcoidosis can also cause lipids. Meningitis. The lesions of the subcutaneous fatty blood vessels also often affect the lipid membrane and cause inflammatory changes.

Panniculitis

The subcutaneous fat layer of panniculitis is composed of lobules composed of adipocytes and connective tissue spaces between lobules. According to the main site of inflammation, panniculitis can be divided into two categories: lobular panniculitis and interval panniculitis. Panniculitis is a broad-spectrum syndrome that can be divided into different sub-categories with different clinical characteristics, related diseases, and pathological changes. In addition to trying to find the diseases and pathogens caused by the disease, the earliest fresh live frugality, removal of a sufficient number of specimens, and a series of pathological sections (at regular intervals, lobular or mixed) is very important.

Causes of panniculitis

The clinical manifestation lacks specificity, and the subcutaneous nodules or plaques with light red to tan are more common, the size and number are variable, and the pain and tenderness are conscious. Skin lesions can occur all over the body, with both lower limbs and hips more common. The course of disease is mostly chronic, and pigmentation and atrophy of varying degrees may remain after healing.

Common types of panniculitis

Nodular erythema and hard erythema are the most common diseases in panniculitis. Other deformed panniculitis are as follows:

Panniculitis nodular febrile non-purulent panniculitis

Also known as Weber-Christian's disease. It is primary lobular panniculitis with unclear etiology. The majority of patients are women. Clinically, it is a recurrent subcutaneous nodule with a diameter of about 2 to 3 cm. The surface is red and tender. It is found on the trunk and limbs. It is more common in the lower limbs. Nodules fade gradually over weeks or months, but new nodules appear from time to time, either individually or in batches. It appears in batches with varying degrees of fever, general weakness, loss of appetite, and joint pain. The disease generally has no visceral damage and has a good prognosis. Histopathological examination was mainly degeneration and necrosis of adipocytes in lobule. The infiltration of most histiocytes and a small number of lymphocytes and plasma cells, thickened blood vessel walls, thickened intima, and extensive fibrosis in the subcutaneous fat in the later stage. The disease should be distinguished from nodular erythema and hard erythema. Nodular erythema is more common in young women and often occurs in spring and autumn. The skin lesion is on the lower leg extension, the nodules are small and shallow, and the surface is red. Scars; hard erythema with large and deep nodules, dark purple-red on the surface, can ulcerate scars, occur in flexion of the calf, and patients often have tuberculosis infection. There is no specific therapy for this disease. The main treatment is to correct the lesion and pay attention to rest. Try salicylate, indomethacin, corticosteroids and antibiotics.

Panniculitis

In the cold environment, it causes local subcutaneous fat damage, which is manifested as purplish-colored subcutaneous nodules or plaques, and the local temperature is relatively low, which occurs in the thighs, buttocks and cheeks. Avoid the cold, pay attention to keep warm, give a high protein, high vitamin diet, the damage can gradually disappear within a few weeks.

Necrosis of neonatal subcutaneous fat

Seen in healthy term newborns, it appears as limited and solid dark red subcutaneous nodules, which occur in the hips, abdomen, and shoulders and backs, and can gradually resolve on their own after weeks or months. The occurrence of this disease may be related to factors such as injury and cold during delivery. Most of the mothers of the children are primiparous primiparas and deliver with forceps. Children should keep warm, strengthen nutrition, and local protection can make the lesions subsided without leaving scars.

Panniculitis

Seen in patients who have been using corticosteroids for a long time, subcutaneous nodules appear on the cheeks, shoulders, back and buttocks after sudden withdrawal or sudden drug reduction, and the skin on the surface is flushed, and the skin color is normal. Patients are more common in children, and most of them take corticosteroids for a long time due to leukemia, nephritis, and so on. No special treatment is needed for this disease, and it can subside slowly after taking a proper amount of corticosteroids.

Traumatic panniculitis

Fat cells are relatively fragile, and trauma can easily lead to subcutaneous fat necrosis, which in turn leads to inflammatory reactions, causing local redness and swelling, and hard plaques, which are more common in obese women and children. Local physiotherapy can promote inflammation absorption and tissue repair.

In addition, some systemic diseases can invade adipose tissue and cause panniculitis, such as deep lupus erythematosus, also known as lupus panniculitis. Subcutaneous nodules often leave obvious atrophic scars after healing. Occurs on the cheeks, hips, and arms. It should also be mentioned that some malignant tumor diseases such as lymphoma malignant histiocytosis and leukemia can also be the main symptoms of subcutaneous nodules or plaques. If misdiagnosed as panniculitis, it will delay treatment and affect the prognosis. Subcutaneous nodules or plaques should be collected for histopathological examination in time for early diagnosis and early treatment.

Pancreatitis TCM Dialectics

Lipitis is similar to the "Meihe Dan" of the motherland medicine. Traditional Chinese medicine believes that the disease is caused by heat and cold, and the meridian is blocked, the blood and blood stagnate, and the camp is out of balance.

Expelling blood circulation, removing stasis, clearing heat and detoxifying.

Fangyi: Yinhua, Zihuadiding, Cork, Mandrill, Poria, Wulingzhi, Curcuma, Cannonball.

Panniculitis treatment

There is no specific treatment for this disease. Fibrinolytic drugs, quinine chloride, azathioprine, cyclophosphamide, etc. have certain effects. In acute inflammation or high fever, the glucocorticoid prednisone 40-60 mg per day and non-steroidal anti-inflammatory drugs have obvious effects. Symptomatic treatment, hormones can be used to control the acute process of inflammation, but when the temperature drops, nodules subside, and often relapse after stopping the drug. If the patient has other autoimmune diseases, the existing immune disease should be actively and correctly treated first. Hormones can be used to control acute symptoms, followed by systemic treatment with traditional Chinese medicine and immunomodulators. In view of the characteristics of the disease's prone to recurrence, during the treatment process Should also be given anti-relapse treatment.

Key points for pancreatitis diagnosis

1 . Clinical features:

(1) Occurs in young women;

(2) It is characterized by recurrent episodes and batches of subcutaneous nodules. After the nodules have subsided, local skin depression and pigmentation of varying degrees appear.

(3) Frequently accompanied by systemic symptoms such as fever, joint pain and myalgia;

(4) When the lesion invades visceral adipose tissue, different symptoms appear depending on the affected part. Extensive internal organs may cause multiple organ failure, major bleeding, or concurrent infections.

2 . Pathological diagnosis: skin nodule biopsy, whose histopathological changes are the main basis for diagnosis, it can be divided into three stages:

(1) The first stage (acute inflammation): degeneration and necrosis of adipose tissue in the lobule, infiltration of neutrophils, lymphocytes and histiocytes, and some accompanied by changes in vasculitis.

(2) The second phase (phagocytosis phase): There are a large number of macrophages infiltrating the degenerate and necrotic adipose tissue, phagocytose the degenerate adipocytes, and form characteristic "foam cells".

(3) The third stage (fibrosis stage): Foam cells are largely reduced or disappeared and replaced by fibroblasts; the inflammatory response is replaced by fibrous tissue, and finally fibrosis is formed.

Diagnosis can be made based on the above clinical and histopathological characteristics, but it needs to be distinguished from the following diseases:

(1) Nodular erythema: Symmetrically distributed subcutaneous nodules can also occur, but the nodules are mostly confined to the extensor side of the calf and do not rupture. They resolve on their own after 3 to 4 weeks, and there are no atrophic scars after healing. Systemic symptoms were mild and no visceral damage. Secondary to other systemic diseases (such as Behcet's disease, etc.), accompanied by symptoms of related diseases. The pathological manifestations were septal pancreatitis with vasculitis.

(2) Hard erythema: It mainly occurs in the middle and lower part of the flexor of the lower leg. The pain is mild, but it can ulcerate and form a hard-to-heal ulcer. Histopathological manifestations were tuberculous nodules or tuberculous granulomas with significant changes in vasculitis.

(3) Histiocytophagic panniculitis: Subcutaneous nodules, recurrent fever, liver and kidney damage, reduced whole blood cells, and bleeding tendency may also occur, but the general condition is critical, progressive, and eventually died of bleeding. Histopathological changes can occur in so-called "bean-shaped" tissue cells that engulf various blood cells and their fragments, which can be distinguished from this disease.

(4) Nodular polyarteritis: A common skin lesion is also a subcutaneous nodule. The center can be necrotic to form an ulcer, but the nodules are distributed along the arteries. The visceral damage is most common in the kidney and heart. Peripheral nerve involvement is very common. Perinuclear neutrophil cytoplasmic antibody (P-ANCA) and hepatitis B surface antigen are positive in diagnostic value. Pathologically confirmed necrotizing vasculitis of the small and medium arteries, and granulocytes and monocytes infiltration in the arterial wall.

(5) Subcutaneous lipid membrane-like T-cell lymphoma: showing high fever, hepatosplenomegaly, pancytopenia, and bleeding tendency, which is very similar to systemic nodular panniculitis. However, there are tumor cell infiltration in adipose tissue, all of which are small and medium polymorphic T cells. The median twisted nucleus and brain gyrus nucleus have important diagnostic value, and reactive phagocytic histiocytes often appear. CD45RO and CD4 were positive for immunohistochemistry, while CD20 was negative.

(6) Malignant histiocytosis: similar to systemic nodular panniculitis, with high fever, hepatosplenomegaly, reduced whole blood cells, erythema, subcutaneous nodules, etc., but the tissue cells are heteromorphic and multinucleated giant cells may appear. Abnormal tissue cells, the disease is more dangerous, the prognosis is extremely poor.

(7) Subcutaneous lipid granulomatosis: skin damage nodules or plaques, 0.5 ~ 3cm, the largest can reach 10 ~ 15cm, the quality is hard, the surface skin is light red or normal skin color, light tenderness, distributed on the face , Trunk and limbs, common on the inner thigh, can gradually retreat after 0.5 to 1 year without leaving atrophy and depression. No systemic symptoms such as fever. The early pathological changes were capsular inflammation of adipose lobes, degeneration and necrosis of adipocytes, infiltration of neutrophils, histiocytes, and lymphocytes, fibrosis at later stages, and cysts of various sizes in the tissue. The disease is prevalent in children, with nodules scattered, no atrophy and depression after regression, no systemic symptoms, and a tendency to self-heal.

(8) Steroidolipitis: children with rheumatic fever, nephritis, or leukemia have used a large number of glucocorticoids in the short term, and subcutaneous nodules appear within 1 to 13 days after the glucocorticoid is reduced or discontinued, and the nodules are 0.5 ~ 4cm in size, the surface of the skin is normal or hyperemic, and it occurs in areas where the subcutaneous fat accumulates most due to glucocorticoid application, such as the cheeks, jaws, upper arms and buttocks. It can subside after weeks or months. , No systemic symptoms, such as increased hormone levels or re-application after discontinuation can also promote nodule resolution. Most cases have no systemic symptoms. Tissue disease can now be seen in the fatty lobules, with foam cells, histiocytes, and foreign body giant cells infiltrating and degenerating fat cells appearing and seeing needle-shaped fissures.

There is no special treatment for this disease, and the skin lesions can subside without scars.

(9) Cold panniculitis: This disease is a type of physical panniculitis caused by cold directly damaging adipose tissue. It is manifested as subcutaneous nodular damage, which mostly occurs in infants and young children, and it is more common in adults with frostbite. Or those with poor blood circulation caused by bodysuits.

The disease occurs frequently in winter. Subcutaneous nodules appear in exposed areas such as the face and extremities after a few hours or 3 days of cold, with a diameter of 2 ~ 3cm. It can also enlarge or merge into plaques, which are hard, tender, It is purple-yellow in color and can gradually fade away without leaving any traces. The main pathological change was acute fat necrosis.

(10) Others: Differentiate from pancreatic panniculitis (pancreatitis and pancreatic cancer), leprosy, trauma or foreign body subcutaneous fat necrosis. In addition, it is necessary to rule out a1 antitrypsin-deficient panniculitis and post-steroidal panniculitis.

Clinical manifestations of panniculitis

Lipid membrane inflammation symptoms and signs: clinically acute or subacute process, characterized by repeated general discomfort, joint pain, fever, and subcutaneous nodules. Nodular panniculitis can be divided into skin type and system type according to the affected site.

Panniculitis skin type

Lesions only invade the subcutaneous adipose tissue without affecting the internal organs. Clinically, they are characterized by subcutaneous nodules. The size of the subcutaneous nodules varies from 1 to 4 cm in diameter and can be as large as 10 cm or more. It appears in groups within a few weeks to a few months, and is symmetrically distributed. It occurs in the thighs and lower legs, and can also involve the upper arms. Occasionally, it is found on the trunk and face. The surface of the pancreatitis is dark red with edema or normal skin color. The subcutaneous nodules are slightly higher than the surface of the skin. The texture is firm and may have spontaneous pain or tenderness. When nodular panniculitis is located deep in the skin, it can move slightly, and when it is shallow, it sticks to the skin and has little mobility. Nodular panniculitis recurs, with intermittent periods of varying lengths. After the nodules have subsided, the local skin has various degrees of depression and pigmentation. This is due to atrophic scars caused by fat atrophy and fibrosis. Some nodules can rupture on their own, and a yellow oily fluid flows out. This is called "Liquefying panniculitis". It mostly occurs in the thigh and lower abdomen, and it is rare to extend the calf. After the formation of irregular scars.

Panicitis is associated with fever in about half of the skin-type patients, which can be low, moderate, or high. Most of the fever types are intermittent or irregular, and a few are relaxation fever. Fever usually starts a few days after the appearance of a subcutaneous nodule, and the duration is uncertain. It gradually decreases after 1 to 2 weeks. It can be accompanied by fatigue, muscle soreness, and loss of appetite. Some cases have joint pain, which is more common in the knee and ankle. Symmetry, persistent or repetitive, the joints can be locally red and swollen, but no joint deformities appear. Most patients can gradually resolve within 3 to 5 years with a good prognosis.

Panniculitis system

In addition to the above skin-type manifestations, there are also internal organ involvement. Visceral lesions can occur at the same time as skin lesions or after skin lesions. In a few cases, extensive internal fat lesions precede skin lesions. Various organs can be affected, including liver, small intestine, mesentery, omentum, retroperitoneal adipose tissue, bone marrow, lung, pleura, myocardium, pericardium, spleen, kidney, and adrenal gland. The fever of systemic panniculitis is generally special, often parallel to the appearance of rashes, most of which are relaxation fever. After the rash appears, the heat gradually rises to as high as 40 ° C, and gradually decreases after 1 to 2 weeks. Digestive system involvement is more common, and in the presence of liver damage can present with dyspnea, hepatomegaly, fatty liver, jaundice, and abnormal liver function. Invasion of the mesentery, omentum, and retroperitoneal adipose tissue can cause abdominal pain, bloating, abdominal mass, intestinal obstruction and gastrointestinal bleeding. Bone marrow involvement may lead to a decrease in whole blood cells. Respiratory system involvement can occur with pleurisy, pleural effusion, hilar shadows, and transient masses in the lungs. Transient renal insufficiency may occur in the kidneys. Involvement of the central nervous system can lead to mental disorders or psychiatric disorders. Pancreatitis has a poor prognosis, and those with extensive internal organs can die from multiple organ failure, or major bleeding in the upper gastrointestinal tract and other parts or nodular panniculitis.