Clinical picture diseases of subcutaneous fat tissue are very monotonous, the primary morphological element of the rash is a reddish, bluish or flesh-colored nodule, which can resolve without a trace, undergo fibrosis or ulcerate. Although there are some Clinical signs(localization and prevalence of nodes, their appearance, developmental features, tendency to decay), an accurate diagnosis, as a rule, can only be established on the basis of an adequate deep biopsy of the node, and the histological section should include the epidermis, dermis, subcutaneous fatty tissue, and sometimes fascia.
Skin diseases, as a rule, do not spread to the subcutaneous fatty tissue, and diseases of the subcutaneous fatty tissue, on the contrary, are localized only in it and rarely secondarily involve pathological process dermis. Sometimes lesions of subcutaneous fatty tissue are part of general disease adipose tissue of the body.
Fat cells(lipocytes) themselves are very sensitive to various pathological stimuli: trauma, ischemia, environmental and inflammatory processes. All these factors lead to necrobiosis or necrosis of lipocytes. With necrobiosis, only part of the fat cells die, others retain the ability for reactive hyperplasia, regeneration and restoration of the hypodermis. Necrosis is characterized by the complete death of lipocytes and the process in these cases always ends with fibrosis. In some cases, fat is released from damaged lipocytes; this fat undergoes hydrolysis to form glycerol and fatty acids.
In response to this, an inflammatory reaction is formed, which sometimes leads to the development of granuloma foreign body. A fairly common histological sign of damage to subcutaneous adipose tissue is the so-called proliferative atrophy, or Wucheratrophie, which means the disappearance of normal adipose tissue and its replacement by fibroblasts and macrophages admixed with more or less inflammatory cells. After the development of proliferative atrophy, it is impossible to establish the cause and nature of the pathological process in the hypodermis using histological examination. It should also be borne in mind that any inflammation in the subcutaneous fatty tissue has more or less pronounced signs of granuloma. The above characteristic response of adipose tissue in the form of necrosis, inflammation and the formation of lipogranulomas is observed only in pathological processes that develop in the hypodermis secondarily or under the influence of exogenous damaging factors. The histological picture of traumatic panniculitis is determined by the nature external influence(trauma, injections of chemicals, etc.), their strength, irritant properties, toxicity. The range of these changes is very wide: from nonspecific inflammation to the formation of granulomas. Fatty substances introduced into the hypodermis can be present in it for a long time without causing any reactions, forming fatty cysts surrounded by multiple layers of the remaining connective tissue, which gives the painting the appearance of Swiss cheese.
Causes of panniculitis there may also be infectious agents and specific disease processes. Inflammation, necrosis and the development of granulomas with subsequent fibrosis of the hypodermis are a consequence of infections such as tuberculosis, syphilis, leprosy, mycosis, etc. The nature of the reaction of the hypodermis in these cases depends on the activity of the infection, the type of pathogen, and the state of the macroorganism; Diseases that can cause panniculitis include malignant lymphomas and others.
Pathological processes that occur in the subcutaneous fat tissue itself are classified according to a number of characteristics. Firstly, the location of origin matters. primary focus inflammatory process, which can be localized in the border zone between the dermis and hypodermis, which is a direct indication of vascular damage (vasculitis); in connective tissue septa (septal panniculitis) or inside fat lobules (lobular panniculitis). Secondly, it is necessary to find out whether the pathological process is caused by primary lesion vessels (arteries, veins, capillaries). Thirdly, it is important to determine the cellular composition of the infiltrate (lymphocytic, neutrophilic, predominantly plasma cells, granulomatous); determine the presence or absence of necrosis, mucin, fibrin or lipid deposits. On degenerative changes in adipose tissue indicates accumulations of calcium or amyloid.
Damage to small vessels usually characterized by local changes involving neighboring areas in the pathological process fat lobules; large-caliber vessels leads to damage to an entire tissue segment that is supplied with blood, and adjacent areas of the dermis are often affected.
Fat destruction, no matter whether traumatic or inflammatory, leads to the release of fatty acids, which in themselves are strong agents, causing inflammation; they attract neutrophils and phagocytic histiocytes and macrophages; phagocytosis of destroyed fat usually leads to the development of lipogranulomas.
Septal processes associated with inflammatory changes, are accompanied by massive edema, infiltration of inflammatory cells and a histiocytic reaction.
Chronic granulomatous inflammatory infiltrate, spreading from thickened connective tissue septa, leads to the development of proliferative atrophy. Repeated attacks of inflammation cause thickening of the interlobular septa, fibrosis and accumulation of histiocytes and giant cells, as well as vascular proliferation.
When large vessels are damaged in the area of connective tissue septa, which is observed with nodular vasculitis, fat necrosis occurs with the development of a massive histiocytic and epithelioid cell reaction inside the fat lobules, followed by the occurrence of fibrosis and then sclerosis of adipose tissue.
Lobular panniculitis is based on primary necrosis of fat cells, which lose their nuclei but retain their cytoplasm (the so-called “shadow cells”). In the area of lipocyte necrosis, an inflammatory infiltrate of neutrophilic and eosinophilic granulocytes, lymphocytes and histiocytes develops. Accumulation neutrophil leukocytes accompanied by the phenomenon of leukocytoclasia. Fat released from lipocytes contains fatty acid, cholesterol, neutral soaps, which in turn enhance the inflammatory response. Histiocytes migrate to the lesion, phagocytizing fat, turning into large foam cells or lipophages. It is also possible to develop epithelioid cell granulomas with giant multinucleated cells. IN last stage fibroblasts appear among the infiltrate cells, young collagen fibers and the process ends with fibrosis. Vessels with lobular panniculitis, as a rule, are involved in the pathological process secondary and insignificantly, only sometimes endothelial proliferation, edema and thickening of the walls are noted in them, and occasionally homogenization.
Panniculitis or fat granuloma is a rare inflammatory process in subcutaneous tissue leading to atrophy and retraction skin. The affected fat cells are replaced by connective tissue, after which nodular, plaque and infiltrate lesions form in their place.
Paniculitis affects both men and women, and it can also occur in children.
The primary, spontaneous form occurs in the female population in age category from 20 to 60 years old, having overweight, accounting for half of all cases. Purchased based on random factors. This type is also called “Weber-Christian syndrome.”
The second half accounts for secondary panniculitis, which occurs due to skin and systemic disorders, during treatment with medications, and exposure to cold.
Photo of Weber Christian's panniculitis
The disease can occur:
Histologically, pathology has 3 phases of its development:
According to its structure, panniculitis is of 4 types:
The secondary form of inflammation and its causes include:
Panniculitis code in international classification diseases are as follows:
M35.6- Recurrent Weber-Christian panniculitis.
M54.0- Panniculitis, affecting cervical region and spine.
Cases of panniculitis may include:
At the onset of spontaneous or Rothman-Makai panniculitis, signs of acute infectious diseases, such as influenza, ARFI, measles or rubella. They are characterized by:
Symptoms are manifested by nodes of varying size and number in the fatty layer of subcutaneous tissue. Nodular lesions can increase up to 35 cm in size, forming a pustular mass, which in the future can lead to rupture and tissue atrophy.
Primary (spontaneous) panniculitis in most cases begins its development with the formation of dense nodes on the thighs, buttocks, arms, torso and mammary glands.
Such spots disappear quite slowly, from several weeks to 1-2 months, sometimes longer periods. After the nodes resolve, atrophic, altered skin with slight retraction remains in their place.
Fatty granuloma is characterized by a chronic (secondary) or recurrent form of the disease, which is considered the most benign. Exacerbations with it occur after a long remission, without any special consequences. The duration of fever varies.
Symptoms of recurrent panniculitis are:
The acute course of the pathology is characterized by the following symptoms:
Therapy acute type little effective, the patient's condition progressively worsens. Within 1 year the patient dies.
The subacute form of the panniculitic inflammatory process, in contrast to the acute one, is milder and is better predicted if treatment is started in a timely manner.
Clinical signs of granuloma depend on the form.
The mesenteric type of the disease is not common; it causes thickening of the mesenteric wall small intestine as a result of inflammation. The cause of the pathology is not fully known. The pathology occurs most often in the male population, less often in children.
Although this type manifests itself mildly, sometimes patients may feel:
Diagnosis of mesentral panniculitis using CT and X-rays does not give clear results and often the disease cannot be detected in a timely manner. To obtain a reliable diagnosis, an integrated approach is required.
To make an accurate diagnosis, a complex of specialists is required: a dermatologist, nephrologist, gastroenterologist and rheumatologist.
For fatty granuloma, the patient is prescribed:
Panniculitis should be differentiated from other similar diseases. For referrals for tests and tests correct diagnosis, you need to consult a good specialist.
Treatment of panniculitis depends on its form and process. For the acute and chronic course of the pathology, the following is prescribed:
At immune types fat granulomas are affected by antimalarial drugs. To suppress the secondary development of inflammation, the underlying disease is treated.
Are used and folk remedies, compresses from plantain, raw grated beets, hawthorn fruits. These compresses help relieve inflammation and swelling of tissues.
Treatment of fatty granuloma requires constant monitoring by a dermatologist or therapist.
Lack of treatment for fatty granuloma can lead to dangerous conditions:
Prevention of panniculitis comes down to eliminating the causes of the disease and treating the main pathologies.
Panniculitis is a progressive process of inflammation subcutaneous tissue, which destroys fat cells, they are replaced by connective tissue, nodes, infiltrates and plaques are formed. In the visceral type of the disease, the fat cells of the kidneys, liver, pancreas, fatty tissue of the omentum or the area behind the peritoneum are affected. In approximately 50% of cases, the pathology takes an idiopathic form, which is mainly observed in women 20-50 years old. The other 50% is secondary panniculitis, developing against the background of systemic and skin diseases, immunological disorders, influence various kinds provoking factors (cold, some medications). The formation of panniculitis is based on a defect in lipid peroxidation.
This inflammation of the subcutaneous tissue can be caused by different bacteria(mainly staphylococci and streptococci). In most cases, its development occurs in lower limbs. The disease may appear after fungal infection, trauma, dermatitis, ulcer formation. The most vulnerable areas of the skin are those that have excess fluid (for example, swelling). Panniculitis can also appear in the scar area after surgery.
In the photo, inflammation of the subcutaneous tissue is difficult to notice.
The main manifestation of spontaneous panniculitis is nodular formations located at different depths in the subcutaneous fat. They usually appear on the legs and arms, rarely on the stomach, chest and face.
After nodular destruction, atrophied foci of fatty tissue remain, shaped like round areas of skin retraction. The nodular variant is characterized by the appearance of typical nodes in the tissue under the skin ranging in size from three millimeters to five centimeters.
The skin over the nodes may be a normal color or bright pink. With the plaque type of inflammation, separate nodular accumulations appear, which grow together and form lumpy conglomerates.
The skin over such formations may be burgundy-bluish, burgundy or pink. In some cases, nodular accumulations spread completely to the tissue of the shoulder, leg or thigh, compressing the vascular and nerve bundles. Because of this, obvious pain appears, lymphostasis develops, and the limbs swell.
The infiltrative type of the disease occurs with the melting of nodes and their conglomerates. In the area of the node or plaque, the skin is bright red or burgundy. Then a fluctuation occurs, which is characteristic of abscesses and phlegmons, but when the nodes are opened, a yellow oily mass is released, not pus. At the site of the opened node, a long-lasting ulcer will remain.
With a mixed type of panniculitis, the nodular form turns into plaque, then into infiltrative. This option is noted in in rare cases. At the onset of the disease there may be fever, muscle and joint pain, nausea, headaches, and general weakness. With visceral inflammation, systemic inflammation of fatty tissue occurs throughout the human body with the formation of specific nodes in the tissue behind the peritoneum and omentum, pancreatitis, hepatitis and nephritis. Panniculitis can last from two to three weeks to several years.
Inflammation of the subcutaneous tissue, or panniculitis, is diagnosed during a joint examination by a dermatologist and nephrologist, rheumatologist, and gastroenterologist. Urine and blood tests, pancreatin enzyme tests, Rehberg test, and liver tests are used. Determination of nodes in visceral type panniculitis occurs thanks to ultrasound examination abdominal organs and kidneys. Blood culture for sterility helps to exclude the septic nature of the disease. An accurate diagnosis is made after obtaining a biopsy of the formation with histological analysis.
There are primary, spontaneous and secondary forms of inflammation of the subcutaneous tissue. Secondary panniculitis are:
Based on the shape of the nodes, nodular, plaque and infiltrative types of the disease are distinguished.
If the first signs of panniculitis appear, you need to consult a doctor. Among other things, you should seek medical attention if you notice new symptoms (persistent fever, drowsiness, extreme fatigue, blistering and expanding areas of redness).
The method of treating inflammation of the subcutaneous tissue is determined by its course and form. With panniculitis nodular chronic type use anti-inflammatory non-steroidal drugs(“Ibuprofen”, “Diclofenac sodium”), antioxidants (vitamins E and C); inject nodular formations with glucocorticoids. Physiotherapeutic procedures are also effective: hydrocortisone phonophoresis, ultrasound, UHF, laser therapy, ozokerite, magnetic therapy.
In the plaque and infiltrative type, the subacute course of the disease is characterized by the use of glucocorticosteroids (Hydrocortisone and Prednisolone) and cytostatics (Methotrexate). Secondary forms of the disease are treated by treating the disease against the background of vasculitis, gout, pancreatitis and red systemic lupus.
For panniculitis preventive measure is timely diagnosis and treatment of primary pathologies - bacterial and fungal infections, vitamin E deficiency.
How does inflammation of the subcutaneous tissue in the legs manifest?
Cellulite, or due to structural changes adipose tissue, often leading to a severe deterioration in blood microcirculation and lymph stagnation. Not all experts consider cellulite a disease, but insist that it can be called a cosmetic defect.
This inflammation of the subcutaneous fatty tissue is shown in the photo.
Cellulite mainly occurs in women as a result hormonal imbalances, which occur periodically: adolescence, pregnancy. In some cases, its appearance can provoke the use of contraceptives hormonal type. Great importance belongs to the factor of heredity and the specifics of the diet.
Lipodystrophy of the tissue under the skin must be treated comprehensively. To achieve success, you need to eat right, drink multivitamins, and antioxidants. Very an important part treatment - sports activities and active breathing.
Doctors recommend a course of procedures to improve blood and lymph circulation - bioresonance stimulation, massage, press and magnetic therapy. Fat cells become smaller after mesotherapy, ultrasound, electrolyolysis and ultraphonophoresis. Use special anti-cellulite creams.
Panniculitis is a progressive inflammation of the subcutaneous fatty tissue, which leads to the destruction of fat cells, their replacement with connective tissue with the formation of plaques, infiltrates and nodes. At visceral form The disease affects the fat cells of the pancreas, liver, kidneys, fatty tissue of the retroperitoneal region or omentum.
Approximately 50% of cases of panniculitis occur in the idiopathic form of the disease, which is more common in women between 20 and 50 years of age. The remaining 50% are cases of secondary panniculitis, which develop against the background of skin and systemic diseases, immunological disorders, and the action of various provoking factors (certain medications, cold). The development of panniculitis is based on a violation of lipid peroxidation.
Causes
Panniculitis can be caused by various bacteria (usually streptococci, staphylococci).
Panniculitis in most cases develops on the legs. The disease can occur after injury, fungal infection, dermatitis, or ulcer formation. The most vulnerable areas of the skin are those with excess fluid (for example, swelling). Panniculitis can occur in the area of postoperative scars.
Symptoms of panniculitis
The main symptom of spontaneous panniculitis is nodular formations that are located in the subcutaneous fat at different depths. They usually appear on the arms, legs, and less often on the face, chest, and abdomen. After the nodes resolve, areas of fatty tissue atrophy remain, looking like round areas of skin retraction.
The nodular variant is characterized by the appearance of typical nodes ranging in size from 3 mm to 5 cm in the subcutaneous tissue. The skin over the nodes can have a color from normal to bright pink.
The plaque version of panniculitis is characterized by the appearance of separate clusters of nodes that grow together and form bumpy conglomerates. The skin over such formations may be pink, burgundy or burgundy-bluish. In some cases, clusters of nodes spread to the entire tissue of the thigh, leg or shoulder, compressing the nerves and vascular bundles. This causes severe pain, swelling of the limb, and the development of lymphostasis.
The infiltrative variant of the disease occurs with the melting of nodes and their conglomerates. The skin in the area of the plaque or node is burgundy or bright red. Next, a fluctuation appears, characteristic of phlegmons and abscesses, but when the nodes are opened, it is not pus that is released, but an oily yellow mass. A long-term non-healing ulcer remains at the site of the opened node.
The mixed version of panniculitis is a transition from a nodular form to a plaque form, and then to an infiltrative one. This option is rare.
At the beginning of the disease there are possible headache, fever, general weakness, pain in muscles and joints, nausea.
The visceral form of the disease is characterized by systemic damage to fatty tissue throughout the body with the development of nephritis, hepatitis, pancreatitis, and the formation of characteristic nodes in the omentum and retroperitoneal tissue.
Panniculitis can last from 2-3 weeks to several years.
Diagnostics
Diagnosis of panniculitis includes examination by a dermatologist together with a nephrologist, gastroenterologist, and rheumatologist.
Blood and urine tests, pancreatic enzyme tests, liver tests, and the Rehberg test are used.
Identification of nodes in visceral panniculitis is carried out using ultrasound examination abdominal organs and kidneys.
Blood culture for sterility helps to exclude the septic nature of the disease.
An accurate diagnosis is established based on the results of a biopsy of the node with histological examination.
Classification
There are spontaneous, primary and secondary forms.
Secondary panniculitis includes:
Immunological panniculitis - often occurs against the background of systemic vasculitis;
Lupus panniculitis (lupus panniculitis) - with a deep form of systemic lupus erythematosus;
Enzymatic panniculitis - associated with the effects of pancreatic enzymes in pancreatitis;
Proliferative cell panniculitis - with leukemia, histiocytosis, lymphoma, etc.
Cold panniculitis is a local form that develops in response to cold exposure;
Steroid panniculitis - occurs in children after completion of corticosteroid treatment;
Artificial panniculitis - associated with the administration of medications;
Crystalline panniculitis - develops with gout, renal failure as a result of deposition of urates, calcifications in the subcutaneous tissue, as well as after injections of pentazocine, meneridine;
Panniculitis associated with α1-antitrypsin deficiency (hereditary disease).
Based on the shape of the nodes formed during panniculitis, infiltrative, plaque and nodular variants of the disease are distinguished.
Patient Actions
At the first symptoms of panniculitis, you should consult a doctor. In addition, you should contact medical care if, during the treatment of the disease, new symptoms are unexpectedly discovered (constant fever, increased fatigue, drowsiness, blisters, increased redness).
Treatment panniculitis
Treatment of panniculitis depends on its form and course.
With nodular panniculitis with chronic course non-steroidal anti-inflammatory drugs (diclofenac sodium, ibuprofen, etc.), antioxidants (vitamins C, E) are used, and nodular formations are injected with glucocorticoids. Physiotherapeutic procedures are also effective: ultrasound, hydrocortisone phonophoresis, laser therapy, UHF, magnetic therapy, ozokerite.
For infiltrative and plaque forms, subacute panniculitis, glucocorticosteroids (prednisolone, hydrocortisone) and cytostatics (methotrexate) are used.
Treatment secondary forms The disease includes therapy for the underlying disease: systemic lupus erythematosus, pancreatitis, gout, vasculitis.
Complications
Abscess;
Phlegmon;
Gangrene and skin necrosis;
Bacteremia, sepsis;
Lymphangitis;
Meningitis (if the facial area is affected).
Prevention panniculitis
Prevention of panniculitis involves timely diagnosis and treatment primary diseases- fungal and bacterial infection, vitamin E deficiency.
DEFINITION , ETIOLOGY and PATHOGENESIS
An inflammatory reaction caused by necrosis of fat cells, mainly of subcutaneous tissue, but can occur in other localizations of the adipose tissue of the macroorganism, as well as various organs and systems. The reason is unknown. Provoking factors: trauma, toxic chemical substances, immunoinflammatory diseases, increased activity of pancreatic enzymes (enzymatic panniculitis), infections. May be accompanied by others systemic diseases connective tissue (systemic lupus erythematosus), lymphoproliferative neoplasms, histiocytosis.
CLINICAL PICTURE AND NATURAL COURSE
The most common is the idiopathic form (Weber-Christian disease); usually occurs in women of the white race. The main symptom: very painful nodular changes in the subcutaneous tissue, usually located on the extremities, less often in the torso area. Relapse of the disease is often preceded by pain in the joints and muscles, as well as low-grade fever. Changes in the subcutaneous tissue persist for several weeks and heal, leaving scars in the shape of a “disc”. Less commonly, fistulas occur, from which oily, sterile contents leak. Sometimes joint damage develops, serous membranes, and the kidneys, liver and hematopoietic system. Nodules in the subcutaneous tissue can coexist with diseases of the pancreas (inflammation, pseudocysts, post-traumatic injury, ischemia), and in some cases arthritis is associated, which makes up a triad of symptoms - panniculitis, arthritis, pancreatitis.
Additional research methods
1. Laboratory research: during relapses there is a significant increase in ESR, leukocytosis with a predominance of neutrophils, anemia, sometimes proteinuria and an increased number of erythrocytes and leukocytes in the urine sediment, increased activity lipase in blood serum (in patients with changes in the pancreas).
2. Histological examination of musculocutaneous biopsy, taken from an inflammatory area of the skin, reveals necrosis of fat cells, the presence of macrophages containing phagocytosed lipids, thrombotic changes in the vessels, and in the late stage - fibrosis.
3. RG of affected joints: narrowing of joint spaces and areas of osteolysis.
Diagnostic criteria
Diagnosis is made based on typical histological changes. It is important to identify lesions in organs other than changes in the subcutaneous tissue that may be associated with panniculitis (eg, this may be the first symptom of pancreatic disease). In persons with mental disorders It is necessary to exclude self-damage to the skin.
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