Inflammation of the subcutaneous adipose tissue. Panniculitis - fibrous inflammation of the subcutaneous tissues, symptoms and treatment

Panniculitis is a progressive process of inflammation of the subcutaneous tissue, which 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, fatty tissue of the omentum or the area behind the peritoneum are affected. 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, and the influence of various 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 can appear after a 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.

With a mixed type of 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, and 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 occurs due to ultrasound examination of the 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 a 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 - a local form that develops as a reaction to exposure to cold;
steroid panniculitis - appears in children after completion of corticosteroid treatment;
artificial panniculitis - caused by the introduction of drugs;
crystalline panniculitis - appears with renal 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. In chronic nodular panniculitis, anti-inflammatory non-steroidal agents (Ibuprofen, Diclofenac sodium), antioxidants (vitamins E and C) are used; 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 with therapy against the background of vasculitis, gout, pancreatitis and systemic lupus erythematosus.

From panniculitis, a preventive measure is the timely diagnosis and treatment 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 is caused by structural changes in adipose tissue, often leading to a strong deterioration in 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 of 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.

Panniculitis is an inflammatory disease that affects the subcutaneous fatty tissue. As a result of pathological processes, fat cells are destroyed and replaced by connective tissue. As a rule, the disease is accompanied by the formation of plaques and nodes.

There are three main forms of panniculitis:

Visceral - in this case, the fat cells of the kidneys, liver, pancreas or omentum are damaged.
Idiopathic form (occurs quite often - 50% of all cases of detection of the disease).
Secondary panniculitis - develops against the background of other diseases, disorders of the immune system, the use of certain medications and other factors.

Secondary panniculitis, in turn, is divided into several types:

Reasons for the development of the disease

The causes of panniculitis can be varied, the most common include:

Bacterial attack. Most often this occurs as a result of the development of staphylococcus or streptococcus in the body.
Trauma or other mechanical damage to tissues and organs.
development of a fungal disease.
Dermatological diseases: ulcers, dermatitis, etc.
Surgical intervention, as a result of which a disease develops at the site of the scar.

In addition, scientists have named the prerequisite, characteristic of all types of panniculitis - a violation of metabolic processes and a large accumulation of toxins and decay products in the body, in particular, in the internal organs and subcutaneous fat.

Symptoms of panniculitis

Panniculitis has very specific symptoms and is quite acute. The first sign is the appearance of nodes under the skin, which can reach a diameter of 5 centimeters. Such neoplasms are located, as a rule, on the limbs, abdomen and chest. After the destruction of the nodes in their place, there are foci of atrophied tissue, the sinking of the skin.

In some cases, plaque formation is observed - an accumulation of several nodes in one place. The skin at the site of such a neoplasm becomes pink or red. Often they spread to the entire area of \u200b\u200bthe limb, which provokes the appearance of edema and lymphostasis.

Often, panniculitis is accompanied by classic symptoms of many diseases:

Deterioration of general well-being.
Headache and.
Pain in muscles, joints and discomfort during movement.
Nausea.

Diagnosis of the disease

A consultation is necessary to diagnose the disease. In some cases, depending on the localization of the disease, the help of a nephrologist, rheumatologist and other specialists is required.

For an accurate diagnosis, the following diagnostic procedures are used:

Treatment of panniculitis

After passing the examination and confirming the diagnosis, the doctor selects the most effective and effective treatment option. The choice of therapy depends on several factors: the cause and form of the disease, the general condition of the patient and the nature of the course of the disease.

Surgery is not used to treat panniculitis. During the operation, it is possible to remove one node, but there is no guarantee that it will not occur elsewhere, since the main cause of the disease has not been eliminated. In addition, scars after such operations heal for a very long time and can provoke the development of infectious processes or other complications.

The treatment of panniculitis must be approached comprehensively. Therapy should include not only narrowly targeted drugs, but also antibiotics, immunostimulants, vitamin complexes. When severe pain occurs, the doctor prescribes broad-spectrum analgesics.

Treatment for nodular panniculitis:

Taking non-steroidal anti-inflammatory drugs, as a rule, it is Ibuprofen or Diclofenac.
Antioxidants are vitamins C and E.
Physiotherapeutic procedures - phonophoresis, ultrasound, magnetotherapy and others.

Cytostatics and glucocorticosteroids are effective in combating the plaque or infiltrative form. A high result was shown by taking Methotrexate, Prednisolone and Hydrocortisone.

Treatment of the secondary form of panniculitis consists in the fight against the underlying disease - pancreatitis, lupus erythematosus, etc. An important point is to strengthen the immune system and take drugs that stimulate its work.

If conservative methods of treatment do not bring the desired result, a blood transfusion procedure is recommended. With an advanced form of the disease, there is a high risk of developing complications - phlegmon, abscess, gangrene, skin necrosis, etc. Rarely, panniculitis results in death. This happens most often if the disease has led to inflammation of the kidneys, a violation of the biochemical balance in the body.

Disease prevention

The main and effective method of preventing panniculitis is the prevention or timely detection and treatment of primary diseases. An important role is played by strengthening the body's defenses, taking general strengthening, tonic drugs, vitamin and mineral complexes.

Panniculitis is a progressive inflammation of the subcutaneous adipose tissue, which leads to the destruction of fat cells, their replacement by connective tissue with the formation of plaques, infiltrates and nodes. In the visceral form of the disease, fat cells of the pancreas, liver, kidneys, fatty tissue of the retroperitoneal region or omentum are affected.

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 develops against the background of skin and systemic diseases, immunological disorders, and the action of various provoking factors (some medications, cold). At the heart of the development of panniculitis is 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 trauma, fungal infection, dermatitis, ulceration. The most vulnerable areas of the skin that have excess fluid (for example, with swelling). Panniculitis can occur in the area of postoperative scars.

Symptoms of panniculitis

The main symptom of spontaneous panniculitis is nodular formations, which are located in the subcutaneous fat at different depths. Usually they appear on the arms, legs, less often - on the face, in the chest, abdomen. After resolution of the nodes, foci of atrophy of adipose tissue remain, looking like round areas of skin retraction.

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

The plaque variant of panniculitis is characterized by the appearance of individual clusters of nodes that coalesce and form tuberous conglomerates. The skin over such formations may be pink, burgundy or burgundy-cyanotic. In some cases, clusters of nodes extend to the entire tissue of the thigh, lower leg or shoulder, squeezing the nerve and vascular bundles. This causes severe pain, swelling of the limb, development of lymphostasis.

The infiltrative variant of the disease proceeds with the melting of the nodes, their conglomerates. The skin in the area of the plaque or node is burgundy or bright red. Then a fluctuation appears, characteristic of phlegmon 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.

A mixed variant of panniculitis is a transition from the nodular form to the plaque, and then to the infiltrative form. This option is rare.

At the onset of the disease, headache, fever, general weakness, muscle and joint pain, and nausea are possible.

The visceral form of the disease is characterized by a systemic lesion of fatty tissue throughout the body with the development of nephritis, hepatitis, pancreatitis, 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, rheumatologist.

A blood and urine test, a study of pancreatic enzymes, liver tests, and a Reberg test are used.

Identification of nodes in visceral panniculitis is carried out using ultrasound examination of the abdominal organs and kidneys.

Blood culture for sterility helps to exclude the septic nature of the disease.

An accurate diagnosis is established by the results of a biopsy of the node with a histological examination.

Classification

Allocate 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 exposure to 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 the end of treatment with corticosteroids;

Artificial panniculitis - associated with the introduction of medications;

Crystalline panniculitis - develops with gout, renal failure as a result of deposition of urates, calcifications in the subcutaneous tissue, and also after injections of pentazocine, meneridine;

Panniculitis associated with α1-antitrypsin deficiency (hereditary disease).

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

Patient's actions

At the first symptoms of panniculitis, you should consult a doctor. In addition, you should seek medical help if new symptoms (persistent fever, increased fatigue, drowsiness, blistering, increased redness) suddenly appear during the treatment of the disease.

Treatment panniculitis

Treatment for panniculitis depends on its form and course.

In chronic nodular panniculitis, non-steroidal anti-inflammatory drugs (sodium diclofenac, ibuprofen, etc.), antioxidants (vitamins C, E), and nodular formations are chipped with glucocorticoids. Physiotherapeutic procedures are also effective: ultrasound, hydrocortisone phonophoresis, laser therapy, UHF, magnetotherapy, ozocerite.

In the infiltrative and plaque form, subacute panniculitis, glucocorticosteroids (prednisolone, hydrocortisone) and cytostatics (methotrexate) are used.

Treatment of secondary forms of 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 (with the defeat of the facial zone).

Prevention panniculitis

Prevention of panniculitis consists in the timely diagnosis and treatment of primary diseases - fungal and bacterial infections, vitamin E deficiency.

The clinical picture of diseases of the subcutaneous adipose tissue is very monotonous., the primary morphological element of the rash is a reddish, cyanotic, or flesh-colored nodule that may resolve without a trace, undergo fibrosis, or ulcerate. Despite the fact that 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 epidermis, dermis, subcutaneous fat, and sometimes fascia.

Skin diseases, as a rule, do not spread to the subcutaneous adipose tissue, and diseases of the subcutaneous adipose tissue, on the contrary, are localized only in it and rarely involve the dermis in the pathological process for the second time. Sometimes lesions of the subcutaneous adipose tissue are part of a general disease of the 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 a part of the fat cells die, while others retain the ability to 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, an inflammatory reaction is formed, which sometimes leads to the development of a foreign body granuloma. A fairly common histological sign of damage to the 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 with an admixture of 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 adipose 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 of external influences (trauma, injections of chemicals, etc.), their strength, irritating properties, and 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 the hypodermis for a long time without causing any reactions, they form fatty cysts surrounded by multiple layers of remaining connective tissue, which gives the picture a Swiss cheese look.

Causes of panniculitis there may also be infectious agents and specific disease processes. Inflammation, necrosis and development of granulomas with subsequent fibrosis of the hypodermis is a consequence of such infections 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, the state of the macroorganism; diseases that may be the causes of panniculitis include malignant lymphomas, and others.

Pathological processes that occur in the subcutaneous adipose tissue itself are classified according to a number of criteria. Firstly, the place of occurrence of the primary focus of the inflammatory process is important, 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 within fat lobules (lobular panniculitis). Secondly, it is necessary to find out whether the pathological process is caused by a primary lesion of blood vessels (arteries, veins, capillaries). Thirdly, it is important to determine the cellular composition of the infiltrate (lymphocytic, neutrophilic, predominantly from plasma cells, granulomatous); establish the presence or absence of necrosis, deposits of mucin, fibrin or lipids. Accumulations of calcium or amyloid indicate degenerative changes in adipose tissue.

Damage to small vessels usually characterized by local changes involving neighboring fat lobules in the pathological process; vessels of large caliber leads to the defeat of the entire tissue segment, which is supplied with blood, while adjacent areas of the dermis are often affected.

Fat breakdown, whether traumatic or inflammatory, leads to the release of fatty acids, which in themselves are strong agents that cause inflammation; they attract neutrophils and phagocytic histiocytes and macrophages; Phagocytosis of the destroyed fat usually leads to the development of lipogranulomas.

Septal processes associated with inflammatory changes are accompanied by massive edema, infiltration by 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, and vascular proliferation.

With the defeat of large vessels 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 fibrosis, and then sclerosis of adipose tissue.

The basis of lobular panniculitis is the primary necrosis of fat cells, which lose their nuclei, but retain the cytoplasm (the so-called “shadow cells”). In the zone of necrosis of lipocytes, an inflammatory infiltrate develops from neutrophilic and eosinophilic granulocytes, lymphocytes and histiocytes. The accumulation of neutrophilic leukocytes is accompanied by the phenomenon of leukocytoclasia. Fat released from lipocytes contains fatty acids, cholesterol, neutral soaps, which in turn increase the inflammatory response. Histiocytes migrate to the lesion, phagocytizing fat, turning into large foam cells (foam cells) or lipophages. It is also possible to develop epithelioid cell granulomas with giant multinucleated cells. In the last stage, fibroblasts, young collagen fibers appear among the cells of the infiltrate, and the process ends with fibrosis. Vessels in lobular panniculitis, as a rule, are involved in the pathological process secondarily and slightly, only sometimes they show endothelial proliferation, edema and thickening of the walls, and occasionally homogenization.

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 lymphatics. 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, the chemical structure of the latter changes, which causes an inflammatory reaction with the appearance of dense nodules (so-called granulomas). Due to the occurrence of these nodules, subcutaneous adipose tissue atrophies, scars form.

The nodules may suppurate and open into fistulas, which may ooze bloody or clear fluid. 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, the connective tissue atrophies. The same result is observed after injections into the subcutaneous tissue of 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 there is no need for specific treatment. 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 with a serious illness (such as diabetes) who regularly inject themselves with drugs should change the injection site. 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. You may need a special blood test. 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. The resulting nodules may be the result of rheumatic pathology or diseases of the 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, sexually transmitted diseases, swollen lymph nodes, inflammation of the intestine. Joint pain and fever occur.