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What to Know About Panniculitis

Medically Reviewed by Dan Brennan, MD on April 13, 2021

Panniculitis an umbrella term that describes inflammation in the bottom layers of the skin. It can be caused by a variety of infections, diseases, or external stimuli. Because it can have so many causes, it can be difficult to diagnose. 

What is Panniculitis?

Panniculitis takes place just under the skin, in the body's fatty layer. Panniculitis can look different depending on its cause or particular situation. Usually, it makes the skin feel hard and become painful and red or darker in some places. 

Often, panniculitis affects the shins and the calves, then spreads to the thighs and upper body. It usually will clear away within six weeks of forming and leave no scar. If anything, sometimes a slight mark, almost like a bruise, will remain but then fade away. 

Symptoms that usually accompany panniculitis include:

Causes of Panniculitis

Conditions like lupus, pancreatic disease, and alpha-1 antitrypsin deficiency can cause panniculitis. It can also result from reactions in your body to things like taking certain drugs or even exposure to cold.

Specifically, the causes of panniculitis are:

  • Infections (viral or bacterial)
  • Inflammatory diseases, like Crohn’s disease or ulcerative colitis
  • Specific medicines, like certain types of antibiotics or contraceptive pills
  • Sarcoidosis, a rare disease that causes your cells to create clumps called granulomas in the skin or lungs 
  • Specific variants of cancer, like leukemia or lymphoma 

Types of Panniculitis

While panniculitis can look different depending on its cause, doctors often place it into one of two categories: septal or lobular. Septal panniculitis affects connective tissue, while lobular panniculitis affects fat lobules.

Panniculitis can also happen when your immune system attacks your own blood vessels. This causes blood vessels to become inflamed and then narrow, close off, or prevent blood flow. Commonly, this type of panniculitis is called erythema nodosum, and it usually happens in your shins. 

Other types of panniculitis include:

  • Erythema induratum. This type of panniculitis almost always appears in young women’s calves. It is typically caused by tuberculosis
  • Cold panniculitis. Also called popsicle panniculitis, this kind occurs in children when they are exposed to the cold. 
  • Subcutaneous sarcoidosis. Subcutaneous sarcoidosis is a side effect of the condition sarcoidosis. 

How Is Panniculitis Diagnosed?

Panniculitis often takes multiple biopsies to diagnose, which can be difficult because of the tissue samples needed. Sometimes blood tests or other medical testing is also needed. 

Panniculitis can be a good indicator that you may have an underlying condition like sarcoidosis, lupus, or multiple sclerosis. Because of this, you might need to consult with more than one physician, including different specialists. 

Treatment for Panniculitis

There is no one treatment for panniculitis. Because there are so many different causes, treatment can vary from case to case. Usually, if panniculitis is caused by an underlying condition, you and your doctor will focus on developing a treatment plan for that condition. However, there are some general pain-management strategies you can use. 

If the panniculitis is caused by a medication, simply stopping the medication and treating some of the symptoms is usually the best course of action. You should always consult with your doctor before abruptly stopping a medication. 

If you have panniculitis from a bacterial infection, your doctor will most likely prescribe anti-inflammatory antibiotics, which will clear up the infection. 

Panniculitis caused by sarcoidosis will most likely go away within the first couple of years in which you have the disease. Treatments for this kind of panniculitis include taking over-the-counter pain relief and wrapping the affected area in bandages. 

While those are treatments for specific types of panniculitis, simple pain management strategies can help until the inflammation from panniculitis goes away. Some of these strategies include taking anti-inflammatory pain killers, drinking a potassium iodide solution, or taking steroids. Simple home treatments like rest, compression socks, and elevating affected areas are also very effective.

Typically, panniculitis comes and goes and can take years to completely go away, even if you are treating it daily. 

WebMD Medical Reference

Sources

SOURCES: 

The Australasian College of Dermatologists: “Panniculitis.”

Derm Net NZ: “Panniculitis.” 

Nemours Foundation/Kids' Health: “A to Z: Panniculitis, Popsicle.”

NHS111: “Panniculitis.”

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