About panniculitis, idiopathic nodular

What is panniculitis, idiopathic nodular?

Idiopathic nodular panniculitis is a rare spectrum of skin disorders characterized by single or multiple, tender or painful bumps below the surface of the skin (subcutaneous nodules) that usually lead to inflammation of the subcutaneous layer of fat (panniculitis). These nodules tend to be 1-2 centimeters large and most often affect the legs and feet (lower extremities). In most cases, idiopathic nodular panniculitis is associated with fever, a general feeling of ill health (malaise), muscle pain (myalgia), and/or abdominal pain. These symptoms may subside after a few days or weeks and may recur weeks, months, or years later. The exact cause of idiopathic nodular panniculitis is not known (idiopathic).

What are the symptoms for panniculitis, idiopathic nodular?

Idiopathic nodular panniculitis usually begins gradually. Abnormal bumps or masses (nodules) appear in the fatty layer under the skin (subcutaneous fat) of the legs, thighs and buttocks. In some patients, the arms, abdomen, and/or face may be involved. These Nodules are usually 1-2 centimeters wide and may be either painful and tender or painless. In some patients, the affected area may become blue and red (erythema), ulcerated (open sore with yellow discharge) and waste away (atrophic), eventually healing and leaving a slight depression after a few weeks.

Another common finding associated with idiopathic nodular panniculitis is recurrent episodes of fever. Additional symptoms include a general feeling of ill health (malaise), fatigue, muscle Pain (myalgia), Joint Pain (arthralgia) and/or abdominal pain. In some patients, weight loss may occur and Nausea may be present. Rarely, Inflammation of skin near the eye (orbital inflammation) may result in abnormal protrusion of the eye (proptosis).

In some patients, Inflammation of the subcutaneous layer of fat (panniculitis) may affect additional organ systems of the body (systemic), potentially resulting in blood abnormalities such as low levels of circulating red blood cells (anemia), liver involvement such as an abnormally large liver (hepatomegaly), Inflammation of blood vessels (vasculitis), sore muscles and joints (polyarthralgia and polymyalgia), piercing of the bowels (perforation) and lung involvement such as accumulation of fluid in the membrane surrounding the lungs (pleural effusion). These systemic events can be life threatening.

What are the causes for panniculitis, idiopathic nodular?

The exact cause of idiopathic nodular panniculitis is unknown. There are numerous different causes that may be associated with the development of panniculitis including Sjogren’s syndrome, inflammatory bowel disease, gout, diabetes mellitus, systemic lupus erythematosus, subacute bacterial endocarditis, tuberculosis, iodide or bromide therapy, withdrawal from large doses of corticosteroids or pancreatitis. Sometimes the cause may be identified as an allergy or possibly a predisposition of fatty tissue to inflammation following cell injury due to an infection or toxin (granulomatous reaction). One hypothesis of the cause of disease is that fat is the trigger of an autoimmune reaction, causing white blood cells to invade the area and cause pathological damage to the subcutaneous fat resulting in the nodules.

What are the treatments for panniculitis, idiopathic nodular?

Treatment of idiopathic nodular panniculitis is symptomatic and supportive. In some patients, skin lesions may heal spontaneously (remission). However, they often return (recur). Affected individuals should receive a thorough clinical examination to determine whether the idiopathic nodular panniculitis is actually occurring secondary to another condition, as treatment of that primary condition may alleviate the symptoms of idiopathic nodular panniculitis.

Non-severe cases that do not include other body systems are treated with pain relieving analgesics (e.g. NSAIDS). If ulcers are present, dressing should be applied to reduce likelihood of infection. For supportive care in patients with severe, uncontrolled pain, opioids may be used. Initial therapy for severe cases includes surgical excision of the nodule and systemic therapy such as an antibiotic (e.g. dapsone, ceftriaxone), immunosuppressant (e.g., azathioprine) or the antimalarial agent hydroxychloroquine. Additional corticosteroid treatment (e.g. prednisone) may be effective under controlled conditions (e.g. limited duration).

What are the risk factors for panniculitis, idiopathic nodular?

Idiopathic nodular panniculitis is a rare spectrum of skin disorders characterized by single or multiple, tender or painful bumps below the surface of the skin subcutaneous nodules) that can be open sores and usually lead to inflammation of the subcutaneous layer of fat (panniculitis).

  • These nodules tend to be 1-2 centimeters in size and most often affect the legs and feet Rare cases involve panniculitis of the breast. In most patients, idiopathic nodular panniculitis is associated with fever, a general feeling of malaise, muscle pain and/or abdominal pain.
  • These symptoms may subside after a few days or weeks and may recur weeks, months or years later and on multiple occasions. The exact cause of idiopathic nodular panniculitis is not known (idiopathic).
  • Autoimmune diseases have been linked to genes that run in families. People with mesenteric panniculitis often have a parent, sibling, or other relative with an autoimmune disease like rheumatoid arthritis or Crohn’s disease.
  • This disease is rare overall, but it’s twice as common in men as in women.
  • Inflammation may be triggered by damage to the skin by, which can be caused by:
  • Infection, surgery, some medicines and injuries
  • Cancer can also cause the mesentery to become inflamed and thickened. Mesenteric panniculitis may affect people with these cancers like lymphoma, carcinoid tumors and colon cancer


Symptoms
Single or multiple, tender or painful bumps below the surface of the skin subcutaneous nodules
Conditions
Single or multiple, tender or painful bumps below the surface of the skin subcutaneous nodules that can be open sores and usually lead to inflammation of the subcutaneous layer of fat
Drugs
NSAIDs antibiotic e.g. dapsone, ceftriaxone,Immunosuppressant like azathioprine

Is there a cure/medications for panniculitis, idiopathic nodular?

Treatment of idiopathic nodular panniculitis is symptomatic and supportive.

  • In some patients, skin lesions may heal spontaneously. However, they often recur.
  • Affected individuals should receive a thorough clinical examination to determine whether the idiopathic nodular panniculitis is actually occurring secondary to another condition, as treatment of that primary condition may alleviate the symptoms of idiopathic nodular panniculitis.
  • Non-severe cases that do not include other body systems are treated with pain-relieving analgesics (e.g., NSAIDS).
  • If ulcers are present, the dressing should be applied to reduce the likelihood of infection.
  • For supportive care in patients with severe, uncontrolled pain, opioids may be used.
  • Initial therapy for severe cases includes surgical excision of the nodule and systemic therapy such as an antibiotic, e.g., dapsone, ceftriaxone, immunosuppressant like azathioprine)
  • Additional corticosteroid treatment, prednisone may be effective under controlled conditions.
  • Treatment of idiopathic nodular panniculitis with oral cyclophosphamide has shown some promise in preliminary clinical trials.
  • Treatment of idiopathic nodular panniculitis with oral cyclosporin A, an immunosuppressive agent, has recently shown some promise.


Symptoms
Single or multiple, tender or painful bumps below the surface of the skin subcutaneous nodules
Conditions
Single or multiple, tender or painful bumps below the surface of the skin subcutaneous nodules that can be open sores and usually lead to inflammation of the subcutaneous layer of fat
Drugs
NSAIDs antibiotic e.g. dapsone, ceftriaxone,Immunosuppressant like azathioprine

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