A Study and Analysis of Panniculitides

Madhavan, R (2010) A Study and Analysis of Panniculitides. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION : The panniculitides comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat. Panniculitis are classified based on histopathological parameters. Panniculitides have been traditionally divided into septal panniculitis, lobular panniculitis, mixed panniculitis and panniculitis with vasculitis. Working classification5 divides panniculitis into mostly septal1 or mostly lobular2 panniculitis, according to the location in which the inflammatory infiltrate is more abundant. They are further divided based on the presence or absence of vasculitis and nature of inflammatory infiltrate. From a clinical standpoint, many forms of panniculitis of diverse etiology closely resemble one another, presenting as tender erythematous subcutaneous nodules. Some panniculitides can be a manifestation of different disease processes, and even if the type of panniculitis is correctly identified, this is only the first step in the series of clinical and laboratory investigations required to determine the underlying causes. From a p athologic standpoint, the subcutaneous fat responds to a variety of insults in a limited number of ways, and therefore, the histopathological difference among various forms of panniculitis may be subtle. Histopathologically there may be overlap between the various forms of panniculitis. Most panniculitis are persistent, lasting for weeks or months. For diagnostic purposes, the biopsy should be taken from an active earlier lesions and serial biopsy may be required in certain conditions. Most of the studies on panniculitides are from the western countries. Studies on this uncommon group of diseases in Indian literature are sparse. We have conducted this study to find out the different patterns and common types of panniculitis in our population. AIM OF THE STUDY 1. To study the clinical and histopathological features of various types of panniculitis. 2. To find out the common types of panniculitis by clinical and histopathological parameters. MATERIALS AND METHODS : A study was conducted during the period from April 2008- October 2009 in the Department of Dermatology, Govt Rajaji Hospital, Madurai Medical College, Madurai, among the patients attending the dermatology department as well as those referred from other departments mainly Medicine, Surgery and Pediatrics. Inclusion Criteria: 1. All patients with clinical features suggestive of panniculitis i.e erythematous subcutaneous nodules or plaques with or without ulceration which was subsequently confirmed by histopathological examination. Exclusion Criteria: 1. Patients who were unwilling for the study. 2. Patients who were diagnosed clinically as panniculitis but the histopathological features not confirming the diagnosis of panniculitis. 3. Patients with abnormal bleeding parameters. A proforma was filled for all patients. History: A detailed history was taken which includes, duration of skin lesions, recurrent nature of lesion, presence or absence of pain, ulceration and systemic symptoms. History of sore throat in the recent past, present or past history of tuberculosis, history of drug intake ,use of oral contraceptives, history suggestive of malignancy and collagen vascular disorders and occupational history. Clinical Examination: Detailed general and systemic examinations including rheumatological examination were done. Detailed examination of skin lesion which includes morphology of skin lesions, distribution of lesions, and number of lesions, symmetry, tenderness, ulceration, induration and size were all recorded. Investigations: 1. Routine laboratory investigations included are complete haemogram, renal function test, liver function test, serum amylase, ASO titre and skin smears for acid fast bacilli 2. Screening for HIV, Hepatitis, and Syphilis were also done for high risk patients with history of sexual exposure or occupational exposure to blood and blood products. 3. Mantoux test : Mantoux test with 5 TU (Tuberculin units) was performed as a routine investigation in all patients 4. Radiological investigations included are chest X ray and U/S for all patients. Doppler studies in patients with suspected lipodermatosclerosis. 5. Tests to rule out malignancy and collagen vascular disorders were done when indicated. 6. Incisional elliptical skin biopsies were done from the representative skin lesions with a caution not to include the resolving lesion and they were sent to pathologist. Special stains like AFB were done by the pathologist when required. Analysis: A descriptive analysis of the clinical characteristics, laboratory parameters and histopathological features of various panniculitis was done. The data was analyzed and compared with published literature. SUMMARY : A prospective study of the clinical and histopathological features of panniculitis was done for a period of 19 months (April 2008-october 2009). Thirty six patients with clinical and histopathological features of panniculitis were included in the study. The average age at presentation was 35.5 years. The male, female ratio was 1.4:1. The common type of panniculitis included Erythema nodosum (12) and Erythema nodosum leprosum (6). The less common types being panniculitis associated with connective tissue diseases (4), Erythema induratum (3) lipodermatosclerosis (2), panniculitis of arthropod bite (2), subcutaneous zygomycosis (2) and pancreatic panniculitis (1). Clinically most of the patients with suspected panniculitis were presented with non specific features of erythematous tender subcutaneous nodules, usually located in the lower limbs. Septal panniculitis without vasculitis was the most common histopathological pattern observed. The clinical and histopathological profile of erythema nodosum was similar to other studies. Most patients of erythema nodosum had evidence of infection in our study. All the cases of lipodermatosclerosis occurred in men in our study which is in contrast to other published studies from the west. We found a significant proportion of patients with ENL presenting as panniculitis in our study. CONCLUSION : 1. Clinicopathological correlation is necessary for the diagnosis and classification of panniculitides. 2. Commonest presentation of panniculitis in our study was subcutaneous nodules in 47% of patients followed by plaque lesions in 30 % and 17% of patients presented with nodules and plaques. Lesions with ulceration were less common (2%). 3. The mean age of presentation was 35.5 years with male female ratio of 1.4:1. All the cases of lipodermatosclerosis were seen only in men in our study. 4. Erythema nodosum and Erythema nodosum leprosum were the commonest type of panniculitis observed in our study 5. Histopathologically, septal panniculitis without vasculitis was present in 33% of cases, mixed panniculitis in 28%, panniculitis with vasculitis in 25% and lobular panniculitis in 14% of cases. 6. Significant proportion of patients with ENL presenting as panniculitis in our study is in consistence with other Indian studies. 7. Septal panniculitis without vasculitis was the common histopathological pattern of panniculitis observed in our study. 8. The unusual variants of panniculitis like panniculitis of arthropod bite, subcutaneous zygomycosis and pancreatic panniculitis were seen in our study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Panniculitides ; Analysis.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 02 Mar 2018 03:24
Last Modified: 03 Mar 2018 02:27
URI: http://repository-tnmgrmu.ac.in/id/eprint/5971

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