Inflammation of the subcutaneous adipose tissue. Panniculitis - what is it

Panniculitis is a progressive process of inflammation of the subcutaneous tissue that destroys fat cells, they are replaced by connective tissue, nodes, infiltrates and plaques are formed. With the visceral type of the disease, the fat cells of the kidneys, liver, pancreas, adipose tissue omentum or area behind the peritoneum. In about 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, which develops against the background of systemic and skin diseases, immunological disorders, influence different kind provoking factors (cold, certain drugs). The formation of panniculitis is based on a defect in lipid peroxidation.

Reasons for the appearance

Such inflammation of the subcutaneous tissue can be caused by various bacteria (mainly staphylococci and streptococci). In most cases, its development occurs on the lower extremities. The disease may appear after fungal infection, injury, dermatitis, ulcer formation. The most vulnerable areas of the skin are those that have excess fluid (for example, with swelling). Also, panniculitis may appear in the scar area after surgery.

In the photo, inflammation of the subcutaneous tissue is difficult to notice.

Symptoms of panniculitis

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 abdomen, chest and face.

After nodal destruction, atrophied foci of fatty tissue remain, having the form of round areas of skin retraction. The nodular variant is distinguished by the appearance of typical nodes in the tissue under the skin ranging in size from three millimeters to five centimeters.

The overlying skin over the nodules may have a normal color or be bright pink. With the plaque type of inflammation, separate nodular clusters appear, which coalesce and form tuberous conglomerates.

Over such formations, the skin may be burgundy-bluish, burgundy or pink. In some cases, nodular accumulations extend completely to the tissue of the shoulder, lower leg or thigh, squeezing the vascular and nerve bundles. Because of this, obvious soreness appears, lymphostasis develops, the limbs swell.

The infiltrative type of the disease passes with the melting of the nodes and their conglomerates. In the area of the node or plaque, the skin is bright red or burgundy. Then there is a fluctuation, which is characteristic of abscesses and phlegmon, however, when the nodes are opened, a yellow oily mass is released, and not pus. In place of the opened node, a long non-healing ulcer will remain.

At mixed type panniculitis, the nodular form passes into a plaque, then into an infiltrative one. This option is noted in rare cases. At the onset of the disease, there may be fever, muscle and joint pain, nausea, headaches, general weakness. With visceral, systemic inflammation of fatty tissue occurs throughout the human body with the formation of specific nodes in the fiber behind the peritoneum and omentum, pancreatitis, hepatitis and nephritis. Panniculitis can last from two to three weeks up to several years.

Diagnostic methods

Inflammation of the subcutaneous tissue, or panniculitis, is diagnosed at a joint examination by a dermatologist and a nephrologist, a rheumatologist, and a gastroenterologist. Urine and blood tests, the study of pancreatin enzymes, Reberg's test, and liver tests are used. The definition of nodes in visceral panniculitis is due to ultrasound abdominal organs and kidneys. Blood culture for sterility helps to exclude the septic orientation of the disease. An accurate diagnosis is made after obtaining a biopsy of the formation with histological analysis.

Classification

There are primary, spontaneous and secondary forms of inflammation of the subcutaneous tissue. Secondary panniculitis are:

immunological panniculitis - often occurs with systemic vasculitis;
lupus panniculitis (lupus) - with a deep lesion of systemic lupus erythematosus;
enzymatic panniculitis - associated with the influence of pancreatic enzymes;
proliferative cell panniculitis - with lymphoma, histiocytosis, leukemia, etc.;
cold panniculitis - local form, which develops as a reaction to exposure to cold;
steroid panniculitis - appears in children after completion of corticosteroid treatment;
artificial panniculitis - caused by the introduction medicines;
crystalline panniculitis - appears when kidney failure, gout due to the deposition of calcifications, urates in the fiber;
hereditary panniculitis, which is caused by a lack of α1-antitrypsin.

According to the shape of the nodes, nodular, plaque and infiltrative types of the disease are distinguished.

Patient's actions

If the first signs of panniculitis appear, you need to see a doctor. Among other things, if new symptoms are detected, medical attention should be sought (persistent fever, drowsiness, extreme fatigue, blistering and increased redness).

Features of treatment

The method of treating inflammation of the subcutaneous tissue is determined by its course and form. With nodular panniculitis chronic type use anti-inflammatory nonsteroidal drugs("Ibuprofen", "Diclofenac sodium"), antioxidants (vitamins E and C); chip off the nodular formations with glucocorticoids. Physiotherapeutic procedures are also effective: hydrocortisone phonophoresis, ultrasound, UHF, laser therapy, ozocerite, magnetotherapy.

In the plaque and infiltrative type, the subacute course of the disease is distinguished by the use of glucocorticosteroids (Hydrocortisone and Prednisolone) and cytostatics (Methotrexate). Secondary forms of the disease are treated by therapy of the disease against the background of vasculitis, gout, pancreatitis and red systemic lupus.

From panniculitis preventive measure is timely diagnosis and therapy of primary pathologies - bacterial and fungal infections, lack of vitamin E.

How does inflammation of the subcutaneous tissue on the legs manifest itself?

Cellulite

Cellulite, or due to structural changes adipose tissue, often leading to a severe deterioration of blood microcirculation and lymph stagnation. Not all experts consider cellulite a disease, but they insist that it can be called a cosmetic defect.

Such inflammation of the subcutaneous adipose tissue is shown in the photo.

Mostly cellulite occurs in women as a result hormonal disruptions that occur periodically: adolescence, pregnancy. In some cases, its appearance can provoke the use of hormonal contraceptives. Great importance belongs to the factor of heredity and the specifics of the diet.

How to get rid?

Lipodystrophy of the tissue under the skin is necessarily treated comprehensively. To achieve success, you need to eat right, drink multivitamins, antioxidants. A very important part of the treatment is sports and active breathing.

Doctors advise a course of procedures to improve blood and lymph circulation - bioresonance stimulation, massage, pressure and magnetotherapy. Fat cells become smaller after mesotherapy, ultrasound, electrolyolysis and ultraphonophoresis. Use special creams against cellulite.

Progressive lesion of subcutaneous adipose tissue inflammatory nature, leading to the destruction of fat cells and their replacement with connective tissue with the formation of nodes, plaques or infiltrates. With the visceral form of panniculitis, the fat cells of the liver, pancreas, kidneys, fatty tissue of the omentum or retroperitoneal region are affected. Diagnosis of the disease is based on the clinic and histological examination data. Treatment for panniculitis depends on its form.

General information

Approximately half of the cases of panniculitis occur in the spontaneous (idiopathic) form of the disease, which is more common in women aged 20 to 50 years. The remaining 50% are cases of secondary panniculitis, which develops against the background of systemic and skin diseases, immunological disorders, the action of various provoking factors (cold, some medications). It is known that the development of panniculitis is based on a violation of lipid peroxidation. But, despite numerous studies in the field of etiology and pathogenesis of this disease, dermatology still does not have a clear idea of the mechanism of its occurrence.

Classification of panniculitis

In the classification of panniculitis, a primary or spontaneous form of the disease (Weber-Christian panniculitis) and a secondary one are distinguished. Secondary panniculitis includes:

immunological - often observed against the background of systemic vasculitis, in children it may be a variant of the course of erythema nodosum;
lupus (lupus-panniculitis) - develops with a deep form of systemic lupus erythematosus, characterized by a combination of symptoms of panniculitis with skin manifestations, typical of discoid lupus;
enzymatic - associated with exposure to pancreatic enzymes, the level of which in the blood increases with pancreatitis;
proliferative-cellular - occurs with leukemia, lymphoma, histiocytosis, etc.
cold - a local form of panniculitis that develops in response to strong cold exposure, manifests itself as dense pink nodes that disappear within 2-3 weeks;
steroid - may occur in children within 1-2 weeks after the end general treatment corticosteroids, is characterized by spontaneous healing and does not require therapy;
artificial - associated with the introduction of certain medications;
crystalline - develops with gout and renal failure due to deposition in subcutaneous tissue urates and calcifications, as well as the deposition of crystals after injections of pentazocine or meneridine;
panniculitis associated with deficiency of α1-antitrypsin (an α-protease inhibitor), - hereditary disease accompanied by systemic manifestations: vasculitis, hemorrhages, pancreatitis, hepatitis, nephritis.

According to the shape of the nodes formed during panniculitis, nodal, infiltrative and plaque variants of the disease are distinguished.

Symptoms of panniculitis

The main manifestation of spontaneous panniculitis are nodular formations located in the subcutaneous fat at different depths. Most often they appear on the legs and arms, less often - in the abdomen, chest or face. After the resolution of the nodes of panniculitis, foci of atrophy of fatty tissue remain, which look like rounded areas of retraction of the skin.

The nodular variant of panniculitis is characterized by the appearance in the subcutaneous tissue of typical separately located nodes ranging in size from 3-4 mm to 5 cm. The skin over the nodes can have a color from normal to bright pink.

The plaque variant of panniculitis is a separate accumulation of nodes, which, growing together, form hilly conglomerates. The color of the skin over such formations is pink, burgundy or burgundy-bluish. In some cases, conglomerates of nodes spread to the entire fiber of the lower leg, shoulder or thigh, while squeezing the vascular and nerve bundles, which causes severe pain and swelling of the limb, leading to lymphostasis.

The infiltrative variant of panniculitis proceeds with the melting of nodes or their conglomerates. In this case, in the area of \u200b\u200bthe node or plaque, as a rule, a bright red or burgundy hue, a fluctuation appears, typical of an abscess or phlegmon. However, when the nodes are opened, it is not pus that comes out of them, but an oily mass. yellow color. At the site of the opened node, a long-term non-healing ulceration is formed.

A mixed variant of panniculitis is rare and represents a transition from a nodular form to a plaque, and then to an infiltrative one.

Changes in the subcutaneous adipose tissue in the case of spontaneous panniculitis may not be accompanied by a violation of the general condition of the patient. But more often at the onset of the disease, symptoms similar to those acute infections(SARS, influenza, measles, rubella, etc.): headache, general weakness, fever, arthralgia, muscle pain, nausea.

The visceral form of panniculitis is characterized by a systemic lesion of fat cells throughout the body with the development of pancreatitis, hepatitis, nephritis, the formation of characteristic nodes in the retroperitoneal tissue and omentum.

In its course, panniculitis can be acute, subacute and recurrent, lasting from 2-3 weeks to several years. acute form panniculitis is characterized by a pronounced change in the general condition with high temperature, myalgia, joint pain, impaired kidney and liver function. Despite the ongoing treatment, the patient's condition progressively worsens, occasionally there are short remissions, but within a year the disease ends in death.

The subacute course of panniculitis is more smoothed. For him, a violation of the general condition, fever, changes functional tests liver, resistance to treatment. The most favorable recurrent or chronic course of panniculitis. At the same time, relapses of the disease are not severe, often without change. general well-being and alternate with long-term remissions.

Diagnosis of panniculitis

The diagnosis of panniculitis is carried out by a dermatologist together with a rheumatologist, nephrologist and gastroenterologist. The patient is prescribed biochemical analysis blood and urine tests, liver tests, pancreatic enzymes, Rehberg's test. Detection of nodes of visceral panniculitis is carried out using ultrasound of the organs abdominal cavity, Ultrasound of the kidneys . pancreas and ultrasound of the liver. Blood culture for sterility eliminates the septic nature of the disease. To differentiate the infiltrative variant of panniculitis from an abscess, a bacteriological examination of a detachable opened node is performed.

An accurate diagnosis of panniculitis is established by the results of a node biopsy. Histological examination reveals inflammatory infiltration, necrosis of fat cells and their replacement with connective tissue. The diagnosis of lupus panniculitis is based on data immunological research: determination of antinuclear factor, antibodies to ds-DNA, complement C3 and C4, antibodies to SS-A, etc.

Differential diagnosis of panniculitis is carried out with erythema nodosum, lipoma, oleogranuloma, insulin lipodystrophy in diabetes mellitus,

Panniculitis (PN) are diseases of a heterogeneous nature, which are characterized by pathological changes in subcutaneous fat (SAT). Often, these diseases also affect the musculoskeletal system.

What is the problem with diagnostics?

Mon are diverse in their clinical and morphological manifestations, there are a large number of forms of the disease, while the criteria that would lead to a common denominator diagnosis on this moment no. Patients with PN turn to different specialists precisely because of the polymorphism of clinical symptoms. Such situations lead to insufficiently rapid diagnosis, and in connection with this, treatment begins untimely.
Classification attempts

At present, there is no classification that would be the same for all countries of the world. Some authors offer their own vision and order Mon according to etiology and pathomorphological picture. Thus, septal (SPN) and lobular are now distinguished panniculitis(LPN), that is inflammatory process located in the septa of the connective tissue and in the lobules of adipose tissue, respectively. Both variants of the disease can be combined with the phenomena of vasculitis and proceed without it.

Erythema nodosum (UE)

UE is a typical representative of septal panniculitis. The immunoinflammatory process in this pathology is nonspecific. There are many reasons for its appearance:

Distinguish between primary and secondary UE. Primary is most often idiopathic. Clinical symptoms, which occur during RE, are characterized by the state immune system, etiology of the disease, localization of the pathological focus, as well as prevalence.

It is possible to diagnose UE only after a carefully collected anamnesis, patient complaints, on the basis of the clinic and research data, laboratory and instrumental.

Brief description of case study #1

The patient is 31 years old and has a history of chronic tonsillitis from 15 years old and frequent appointments antibiotics for him. In 2009, painful nodes were discovered after another exacerbation of tonsillitis. The knots were located on the left leg. Treatment with glucocorticosteroid hormone dexamethasone was carried out, after which a positive trend was observed. After 3 years, tonsillitis provoked the appearance of 2 more nodes on the legs. After two months of homeopathic therapy, the nodes regressed. At the end of the year, there was a recurrence of painful formations on the lower leg.

Upon admission general state Satisfactory, normosthenic physique, body temperature is normal. Other indicators of examination and laboratory tests were also not changed.

On palpation of the formations on the lower leg, pain is noted. Ultrasound of the node revealed an area of some blurring with increased echogenicity and a high content of blood vessels.

The diagnosis made by the doctors sounded like stage 2-3 erythema nodosum and chronic tonsillitis. After treatment with benzylpenicillin, non-steroidal anti-inflammatory drugs, introduction of a protective regimen and local treatment with sodium clobetasol and heparin ointments, the disease regressed after 21 days. There were no exacerbations of pathology during the year.
Of the causes of the disease in the first place with streptococcal infection 9a, the above case indicates the association of UE (septal panniculitis) with streptococcal infection, in particular, with tonsillitis) is sarcoidosis.

Case Brief #2

A 25-year-old patient was admitted to the hospital with complaints of painful nodules on her legs and arms, pain in many joints (ankle, wrist), swelling in them, fever up to 39C, excessive sweating.

She fell ill on December 7, 2013, when arthritis of the ankle joint appeared for the first time. After 2 days, nodes appeared on the legs, which were sharply painful. A few days later, a large number of the same formations appeared with symptoms of general intoxication (fever, sweating).

After examination, the therapist was diagnosed with a probable reactive arthritis. Dexamethasone was used for treatment. The effect turned out to be positive. However, relapses continued.

According to laboratory data, inflammatory changes were determined in the blood. On CT scans chest enlarged lymph nodes were determined and there were signs of chronic. On ultrasound of the node, its structure was lumpy, some areas were non-echoic and rich in vessels.

After consultation with a pulmonologist, sarcoidosis of the intrathoracic lymph nodes was exposed. The final diagnosis looked like Löfgren's syndrome, sarcoidosis of the lymph nodes of the chest at stage 1, secondary UE, polyarthritis, febrile syndrome.

The patient was treated with dexamethasone with cyclophosphamide parenterally. Then methylprednisolone was prescribed orally. Cyclophosphamide was also administered weekly, accompanied by a non-steroidal anti-inflammatory drug. The therapy led to a positive dynamics of the disease and at the moment the patient is under the supervision of doctors.

Differential diagnosis of UE

There are many diseases clinical picture which is similar to the symptoms of UE, so it is necessary to conduct a thorough differential diagnosis. If differential diagnosis is carried out incorrectly or out of time, inadequate therapy is prescribed, which leads to a prolongation of the disease and the appearance of various complications and a deterioration in the quality of human life.

Example of a clinical case No. 3

A 36-year-old patient came to the hospital for medical care at the beginning of 2014 in connection with complaints of induration of the lower leg, which was painful. The patient believes that the disease first appeared in 2012 after (SARS). Then on the shin arose painful induration. The doctors diagnosed thrombophlebitis. Treated with vascular medicines physiotherapy was prescribed. The patient completed the treatment with positive dynamics. In April 2013, the painful induration reappeared. were held laboratory research that showed no inflammatory changes. Ultrasound of the veins revealed insufficiency of the perforating veins of the leg. The patient was referred for a consultation at the NIIR them. V.A. Nasonova, where during the examination a seal was found on the lower leg. Laboratory and instrumental research within the normal range. On ultrasound of the internal organs, some diffuse changes pancreas and liver. On the ultrasound of the node, microvascularization, clumpy structure and thickening of the pancreas.
After all examinations and consultations, a diagnosis of lobular panniculitis, chronic course, lipodermatosclerosis. Varicose veins veins lower extremities. Chronic venous insufficiency class IV.

Treated with hydroxychloroquine due to weak activity illness. A month later, the dynamics of the disease is positive.

Discussion of specific cases

We have brought to your attention 3 different cases differential diagnosis which are currently very common.

In the first patient after streptococcal infection on the background of antibiotics and anti-inflammatory drugs, the disease regressed. Moreover, we note the color dynamics of formations on the skin: a pale red color at the beginning to a yellow-green color at the end of the disease, the so-called bruise flowering symptom.

For UE, this dynamics is very typical and even on late stages illness can be identified. The nodules themselves disappear without a trace after 3-5 weeks. Skin atrophy and scarring are not observed.
Simultaneously with skin manifestations, articular syndrome also manifests. There are pains and swelling in the joints in half of the patients with UE. The most common lesion of the ankle joints. Regression of arthritis is observed within six months. Such patients do not develop heart disease, as in rheumatic fever, even though joint pain appears after a primary streptococcal infection.

If patients with UE have valvular pathology of the heart, it does not worsen. In this regard, we can say that UE is not a reflection of the activity of the rheumatic process.

UE and sarcoidosis

Against the background of sarcoidosis, UE has features of the course and manifestations:

swelling of the legs, which often precedes UE;
severe pain in the joints;
there are a lot of elements of skin seals and they are extremely common, while each element is capable of merging with another similar node;
localization of nodes mainly in the area of the legs;
the dimensions of the elements are large, more than 2 cm in diameter;
in laboratory tests there may be an increase in the titer of antibodies to antistreptolysin-O and to Yersinia;
defeat respiratory tract with symptoms such as shortness of breath, chest pain, cough.

UE (septal panniculitis), hilar lymphadenopathy, fever, and joint involvement suggest Löfgren's syndrome. Despite this, enlarged lymph nodes can be

Panniculitis or fatty granuloma is a rare inflammatory process in the subcutaneous tissue, leading to atrophy and retraction. skin. Affected fat cells are replaced by connective tissue, after which nodular, plaque and infiltrate foci are formed in their place.

Prevalence and classification

Paniculitis affects both men and women, it can also occur in children.

The primary, spontaneous form occurs in the female population in age category from 20 to 60 years old, with overweight accounts for half of all cases. Acquired by random factors. This type is also known as Weber-Christian syndrome.

The second half is due to secondary panniculitis, which occurs due to skin and systemic disorders, in the treatment of medicines, exposure to cold.

Photo of Weber Christian panniculitis

The disease can proceed:

Acute or subacute. Starts fast, progresses to chronic form. The clinic is accompanied by high fever, pain in the muscles and joints, malfunctions in the liver and kidneys.
Recurrent. Symptomatically manifests itself for 1-2 years, the nature of the disease is severe with remission and relapses.

Histologically, pathology has 3 phases of its development:

First. It is manifested by inflammation and accumulation in the subcutaneous fatty tissues of blood and lymph.
Second. At this stage adipose tissue undergoes changes, necrosis occurs.
Third. Scarring and thickening occurs, necrotic foci are replaced by collagen and lymph with the addition of calcium salts to them, subcutaneous calcification develops.

According to its structure, there are 4 types of panniculitis:

Nodal. Appearance nodes are characterized by a reddish or bluish hue with a diameter of 3 to 50 mm.
Plaque. This form has multiple blue-bumpy nodular formations on large areas of the body, for example: legs, back, hips.
Infiltrative. Outwardly, it resembles an abscess or phlegmon.
Visceral. Serves the most dangerous view panniculitis, as it causes disturbances in adipose tissues internal organs: liver, pancreas, liver, kidneys, spleen.
Mixed or lobular panniculitis. This type begins with a simple node, which then degenerates into a plaque, and then into an infiltrative one.

The secondary form of inflammation and their causes include:

Immunological. It is noticed that this species occurs with systemic vasculitis or is one of the options for erythema nodosum.
Lupus or lupus panniculitis. Occurs against the background of serious manifestations of lupus erythematosus.
Enzymatic. Develops with pancreatitis, due to high doses effects of pancreatic enzymes.
Proliferative-cellular. Its cause is blood cancer (leukemia), lymphoma tumors, histiocidosis, etc.
Kholodova. Clinically manifests itself as nodular formations of a pink hue, passing independently after 2-3 weeks. The cause of cold panniculitis is exposure to low temperatures.
Steroid. The reason for it is the abolition of corticosteroids in children, the disease goes away on its own, so treatment is excluded.
Artificial. Its occurrence is associated with medications.
Crystal. It is caused by the deposition of urates, calcifications against the background of gouty pathology, renal failure, also after injections with pentazocine and meneridine preparations.
Hereditary. Associated with a deficiency of 1-antitrypsin - manifests itself as hemorrhages, pancreatitis, vasculitis, urticaria, hepatitis and nephritis. Is genetic pathology transmitted through family ties.

ICD-10 code

Panniculitis code in international classification diseases are as follows:

M35.6- Recurrent Weber-Christian panniculitis.
M54.0- Panniculitis, striking cervical region and spine.

The reasons

Cases of panniculitis can be:

Bacteria, more often it is streptococci, staphylococci, tetanus, diphtheria, syphilis;
Viruses such as rubella, measles and influenza;
fungal skin lesions nail plates and mucous;
Weak immunity. Against the background of HIV infection, diabetes, treatment with chemotherapy and other drugs;
Lymphedema disease. With it, swelling of the soft tissues is observed;
Horton's disease, periarteritis nodosa, microscopic polyangiitis and other systemic vasculitis;
Traumatic damage to the skin, dermatitis, postoperative scars;
Narcotic substances administered intravenously;
Dangerous degree of obesity;
Systemic lupus erythematosus;
Pulmonary insufficiency of congenital type;
Congenital or acquired change in the metabolic process in the adipose tissue of the body;
. Skin inflammation means unexpressed rage, or the inability to show it at the right time.

Symptoms of primary and secondary panniculitis

At the onset of spontaneous or Rothman-Makai panniculitis, there may be signs of acute infectious diseases, such as influenza, SARS, measles or rubella. They are characterized by:

malaise;
headache;
body heat;
arthralgia;
myalgia.

Symptoms are manifested by nodes of various sizes and number in the fatty layer of subcutaneous tissues. Nodular lesions can increase up to 35 cm in size, forming a pustular mass, in the future this can lead to tissue rupture and atrophy.

Primary (spontaneous) panniculitis in the majority begins its development with the formation of dense nodes on the thighs, buttocks, arms, trunk and mammary glands.

Such spots disappear rather slowly, from several weeks to 1-2 months, there are also longer periods. After resorption of the nodes, atrophic altered skin with a slight retraction remains in their place.

Fat 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 the fever varies.

Symptoms of recurrent panniculitis are:

chills;
nausea;
pain in the joints and muscle tissues.

The acute course of the pathology is characterized by such signs:

violation of the kidneys;
enlargement of the liver and spleen;
tachycardia may be observed;
anemia;
leukopenia with eosinophilia and a slight increase in ESR.

Therapy of the acute type is not very effective, the patient's condition progressively worsens. The patient died within 1 year.

The subacute form of the panniculitis inflammatory process, in contrast to the acute form, is milder and is better predicted with timely treatment.

Clinical signs of granuloma depend on the form.

Symptoms of types of fatty granuloma

Signs of mesenteric panniculitis

The mesenteric type of the disease is not common, with it there is a thickening of the mesenteric wall small intestine as a result of inflammation. The cause of the pathology is not fully known. Pathology manifests itself most often in the male population, less often in children.

Although this type manifests itself weakly, sometimes patients may feel:

high temperature;
abdominal pain, moderate to severe;
nausea and vomiting;
weight loss.

Diagnosis of mesentrial 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.

Diagnostics

For staging accurate diagnosis a complex of specialists is needed: a dermatologist, a nephrologist, a gastroenterologist and a rheumatologist.

With fatty granuloma, the patient is prescribed:

Biochemical and bacteriological analysis of blood, with the determination of the level of ESR;
Urine examination;
Checking the liver with a sample;
Examination of the kidneys for cleansing ability;
Analysis of pancreatic enzymes;
Ultrasound of the abdominal cavity;
Biopsy with histology and bacteriology;
Immune examination.

Panniculitis should be differentiated from other similar diseases. For referral to tests and the correct diagnosis, it is necessary to consult a good specialist.

Treatment

Treatment of panniculitis depends on its form and process. about spicy and chronic course pathologies are prescribed:

bed rest and plentiful drink, from 5 glasses a day. : alcoholic drinks, tea and coffee.
A diet enriched with vitamins E and A. Fatty and overcooked foods are prohibited.
benzylpenicillin and prednisone.
Analgesics.
Anti-inflammatory drugs.
Antioxidants and antihypoxants.
Injections of cytostatics and corticosteroids.
Antibiotics, as well as antiviral and antibacterial drugs.
Hepatoprotectors for the normalization of liver function.
Vitamins A, E, C, R.
Physiotherapy.
Surgical removal of pus and necrotic areas.

At immune species fat granulomas involve antimalarial drugs. To suppress the secondary development of inflammation, the underlying disease is treated.

Used and folk remedies, compresses from plantain, raw grated beets, hawthorn fruits. These compresses help relieve inflammation and swelling of the tissues.

Treatment of fatty granuloma requires constant supervision by a dermatologist or therapist.

Possible consequences

Lack of treatment of adipose granuloma can lead to dangerous conditions:

sepsis;
meningitis;
lymphangitis;
gangrene;
bacteremia;
phlegmon;
skin necrosis;
abscess
hepatosplenomegaly;
kidney disease;
death.

Preventive actions

Prevention of panniculitis comes down to eliminating the causes of the disease and treating the underlying pathologies.

Diseases of the subcutaneous adipose tissue are diseases of the elastic connective tissue of the muscles, bones of the skeleton, as well as the tissue that is located under the epidermis and dermis (actually the skin). Adipose tissue is composed of fat cells interspersed with connective tissue fibers, nerve fibers and lymphatic vessels. In the subcutaneous tissue there are also blood vessels that feed the human skin. Fats are deposited in the subcutaneous adipose tissue of the human body. If fats enter the surrounding tissues, then the chemical structure of the latter changes, which causes inflammatory response with the appearance of dense nodules (the so-called granulomas). Due to the occurrence of these nodules, subcutaneous adipose tissue atrophies, scars form.

The nodules may suppurate and open into fistulas from which blood or clear liquid. Often, new ones form around existing granulomas. After the lesions heal, large depressions remain on the skin. Sometimes the arms, thighs, shins, torso, chin and cheeks are involved in the inflammatory process.

Symptoms

Reddened, inflamed, hot to the touch skin.
Knotty seals.
Loose skin. Scarring.
Sometimes joint pain, fever.

Causes

Diseases of the subcutaneous adipose tissue are divided into panniculitis, tumors and tissue growths. Knots made up of connective tissue can become inflamed (for example, as a result of trauma). After the introduction of insulin and glucocorticoids into the affected areas connective tissue atrophies. The same result is observed after injections into the subcutaneous tissue. oil solutions used in cosmetology.

Redness of the skin, phlegmon, nodules, scarring of the skin - all these symptoms are also observed in diseases of the pancreas. These changes occur in the navel and on the back. Often the cause of inflammation of the subcutaneous adipose tissue cannot be established. The cause of the formation of nodules in newborns is considered to be mechanical trauma during childbirth, but this version has not been proven. This is the so-called necrosis of the subcutaneous tissue of newborns. The prognosis in this case is favorable and specific treatment not necessary. Spontaneous panniculitis is known.

Treatment

If a person does not suffer from any other disease that needs specific treatment, then lotions and dressings with anti-inflammatory ointments are prescribed to him. Only in exceptional cases does the patient need to take medication (eg prednisolone).

Patients suffering serious illness(for example, diabetes mellitus) and regularly injecting themselves with drugs, they should change the place of injections. After the injection of the drug into the muscle, it is necessary to carefully monitor the skin at the injection sites.

If you notice any changes in the skin (redness, painful nodules or indurations under the skin when pressed), you should consult a doctor.

First, the doctor will ask the patient about all the general ailments, then carefully examine his skin. May need special analysis blood. If you suspect a lesion of the subcutaneous tissue, the doctor will perform special diagnostic procedures.

Course of the disease

As a rule, after inflammation of the subcutaneous adipose tissue, scars remain on the skin. Exacerbations of the disease are extremely rare. The prognosis depends on the specific cause that caused the disease.

In winter, in young children, the skin on the cheeks and chin becomes inflamed from the cold (this is due to the fact that when the kids are in the stroller, the skin freezes in these places). If there are no other lesions after such inflammation, no scars remain.

Many diseases are accompanied by damage to the subcutaneous tissue. Emerging nodules may be the result of rheumatic pathology or diseases blood vessels. If a person suffers from erythema nodosum, then loose painful bluish foci appear in the subcutaneous tissue. They can also be observed with heart defects, venereal diseases, swollen lymph nodes, inflammation of the intestines. Joint pain and fever occur.