Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 14, 2016

Skin diseases and other conditions associated with the skin can be damaging, discomforting and disfiguring. Although uncommon, panniculitis in its various forms and types, is no exception. Those who suffer from the disease deal with inflammation of subcutaneous tissue (directly under the skin) on different parts of the body. Panniculitis is treated through various therapies, dependent upon the degree of affliction along with any other underlying conditions that may coincide with it.


Definition & Facts

Panniculitis is a group of rare skin disorders that concern the inflammation of subcutaneous fat (fat, or adipose tissue, that lies directly under the skin), which can occur in any fatty tissue. Though it has differing forms, the actual appearance of the disorder usually exhibits a uniform, outward aspect. It is distinguished by either single or multiple bumps or nodules below the skin's surface that can be both tender, hard and painful, which directly lead to the irritation and inflammation of the fat layer.

The term panniculitis, actually means "inflammation of fat tissue." It can be classified as septal when inflammation affects connective tissues or lobular, when inflammation affects fat lobules. One of the most common forms of panniculitis, erythema nodosum, which occurs in the shin area, comprises a number of panniculitis cases and its causes are unknown.

It is also commonly classified based on the presence or lack of systemic (affecting the body as a whole) symptoms. Panniculitis without systemic disease can be caused by cold or trauma; whereas, panniculitis with systemic disease can be caused by connective tissue disorders (lupus, scleroderma) as well as lymphoma, pancreatitis, pancreatic cancer, sarcoidosis, and other conditions.

Differentiations with classification can usually be distinguished through microscopic examination to determine the degree of inflammation. A further classification of panniculitis, subcutaneous vasculitis, is determined by the involvement and presence of blood vessel inflammation (vasculitis) in which the immune system attacks the blood vessels. They can either be narrowed or closed and blood flow to organs disrupted, which could damage organs.

Symptoms & Complaints

Symptoms are usually characterized by a general run-down feeling, ill health, fatigue, muscle pain, joint pain, reoccurring fever, single or multiple painful nodules usually under an inch in size, which are located in the underlying skin tissue of the cheeks, forehead, legs, feet, thighs, shins, calves, abdomen, buttocks, and other parts of the body, such as the arms and facial area.

Other symptoms, depending upon the degree of involvement, may include unintentional weight loss, abdominal pain, nausea, concave/depressed appearing areas of the skin, ulceration with discharges, pigmented outside skin (erythematous), inflammation of the skin around the eye (rare), and eye protrusion.

Complaints by patients typically consist of skin sensitivity with the existence of painful, rigid, reddish skin lesions and nodules of irregular shapes along with weakness, headaches, joint pain, and muscle pain, sweating, and nausea on occasion. Other complaints usually concern disease related symptoms associated with panniculitis.


Oftentimes the causes of panniculitis are unknown but the possibilities are endless and range from the purely physical factors such as cold and trauma, particularly with fat tissue death (necrosis) in newborns, to viral infections or bacterial infections (tuberculosis), and inflammatory diseases such as Crohn's disease and ulcerative colitis.

Other factors involve associations with conditions such as disorders of connective tissue, like lupus and scleroderma. Other associations entail endocarditis (inflammation of the heart valve), corticosteroid withdrawals, pancreatitis, and pancreatic cancer. The causes may even be related to allergic reactions along with the tendency of fat tissue to react with tumors composed of granulated tissue that are formed in reaction to infection, inflammation, or unknown causes.

Additional causes include medicines such as birth control pills and sulphonamides (an antibiotic group) as well as sarcoidosis (rare disease that causes cells to clump in the lungs and skin); leukemia (cancer of the blood - white blood cells), and lymphoma (cancer of the lymphatic system).

Some cases are caused from the immune system of the body inadvertently attacking the fat cells. Other cases are impacted by the actual inflammation of the underlying fat layer that affect the organ systems of the body that result in abnormalities of the blood that include anemia (red blood cell circulation), the liver (enlarged liver) and lung involvement (fluid accumulation surround the lungs/pleural effusion).

Diagnosis & Tests

Diagnosing panniculitis can be difficult due to the different forms of the condition and the relationship it often carries with other diseases. Findings are usually through conscientious clinical procedures, assessment of patient risk factors, the careful examination of the distribution and patterning of lesions and nodules as well as skin ulceration, atrophy (wasting), and sclerosis (hardening of the skin) issues. Microbiological cultures, tissue biopsy findings and other investigations are sometimes necessary to differentiate panniculitis types and the conditions related to them.

Treatment & Therapy

With the various forms of panniculitis, treatment is directed to the underlying cause (if known) of the condition, so treatments will vary. If medication or allergic reaction to medication is the cause, the medicine will be stopped and alternatives will be found. If the cause is found to be a bacterial infection, antibiotics will be administered to fight the infection. Many times everyday lifestyle changes, over-the-counter pain relievers (ibuprofen), and support/compression hose or bandages may be all that are required to manage any breakouts or flareups.

Other treatments for skin nodule and joint pain involve surgical removal of the affected skin area, the use of potassium iodide for skin problems (affects white blood cells), topical corticosteroid creams, tablets or injections and immunosuppressants (for immune system compromise). If the nodules or lesions have increased in both size and number and other layers of the skin and organs are affected, more serious treatments are considered,

Prevention & Prophylaxis

With panniculitis causes either being sketchy or hard to diagnose, prevention can be difficult to determine, but doctors attempt to manage the condition through symptom relief. Controlling the risk factors associated with bacterial infections, fungal infections, and viral infections are also preventative measures that doctors and patients can take. In the most critical case, corticosteriod treatment may be effective under strictly controlled conditions.

Rest is essential and elevation of the affected area is critical. There are also surgical considerations when treatments are ineffective. Removal of skin patches by a skin specialist is an option when other treatments are not working.

Panniculitis can be exacerbated by spicy and fried foods, so steering clear of these foods is critical. Nutrition is of importance as is fasting. Avoidance of stress with focus on comfort, rest, health, exercise, and improving the immune system are critical preventative measures.