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Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Mini-Review Article

Panniculitis: A Cardinal Sign of Autoinflammation

Author(s): Tiago Borges* and Sérgio Silva

Volume 20, Issue 4, 2024

Published on: 26 October, 2023

Page: [350 - 360] Pages: 11

DOI: 10.2174/0115733971254702231020060633

Price: $65

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Abstract

Panniculitis was first described in the nineteenth century and is characterized by inflammation of the subcutaneous fat. It may be categorized in septal or lobular subtypes, but other histopathological features (e.g., presence of vasculitis, nature of inflammatory infiltrates, characteristics of fat necrosis) are also important for diagnostic purposes. Clinically, panniculitis is characterized by the presence of subcutaneous nodules, and both ulcerative and nonulcerative clinical subtypes have been proposed. In this review, we aimed to describe the occurrence of panniculitis in autoinflammatory disorders (AIDs) and related diseases.

Among monogenic AIDs, panniculitis is common in IFN-mediated disorders. Panniculitis is a distinctive feature in proteasome-associated autoinflammatory syndromes (PRAAS), including chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome and Nakajo-Nishimura syndrome. On the other hand, erythema nodosum corresponds to the most common clinical form of panniculitis and is common in polygenic AIDs, such as Behçet’s syndrome, inflammatory bowel disease, and sarcoidosis. Cytophagic histiocytic panniculitis, lipoatrophic panniculitis of children, and otulipenia are rare disorders that may also present with inflammation of the subcutaneous fat. Therefore, panniculitis can identify a specific subgroup of patients with AIDs and may potentially be regarded as a cardinal sign of autoinflammation.

Graphical Abstract

[1]
Requena L. Normal subcutaneous fat, necrosis of adipocytes and classification of the panniculitides. Semin Cutan Med Surg 2007; 26(2): 66-70.
[http://dx.doi.org/10.1016/j.sder.2007.02.001] [PMID: 17544956]
[2]
Cascajo CD, Borghi S, Weyers W. Panniculitis. Am J Dermatopathol 2000; 22(6): 530-49.
[http://dx.doi.org/10.1097/00000372-200012000-00009] [PMID: 11190446]
[3]
Polcari IC, Stein SL. Panniculitis in childhood. Dermatol Ther 2010; 23(4): 356-67.
[http://dx.doi.org/10.1111/j.1529-8019.2010.01336.x] [PMID: 20666823]
[4]
Wick MR. Panniculitis: A summary. Semin Diagn Pathol 2017; 34(3): 261-72.
[http://dx.doi.org/10.1053/j.semdp.2016.12.004] [PMID: 28129926]
[5]
Guhl G, García-Díez A. Subcutaneous sweet syndrome. Dermatol Clin 2008; 26(4): 541-551, viii-ix.
[http://dx.doi.org/10.1016/j.det.2008.06.003] [PMID: 18793988]
[6]
Llamas Velasco M, Pérez-Gónzalez YC, Kempf W, Paredes BE, Cerroni L, Fernández Figueras MT. Clues in Histopathological Diagnosis of Panniculitis. Am J Dermatopathol 2018; 40(3): 155-67.
[http://dx.doi.org/10.1097/DAD.0000000000000985] [PMID: 29470303]
[7]
Sutra-Loubet C, Carlotti A, Guillemette J, Wallach D. Neutrophilic panniculitis. J Am Acad Dermatol 2004; 50(2): 280-5.
[http://dx.doi.org/10.1016/j.jaad.2003.10.006] [PMID: 14726888]
[8]
Ryan TJ. Panniculitis. Clin Dermatol 1989; 7(4): 120-48.
[http://dx.doi.org/10.1016/0738-081X(89)90047-3] [PMID: 2691047]
[9]
Aguirre-Martinez IL, Torrelo A. Lipoatrophic panniculitis of children. Clin Dermatol 2021; 39(2): 220-8.
[http://dx.doi.org/10.1016/j.clindermatol.2020.10.010] [PMID: 34272014]
[10]
Eberhard BA, Ilowite NT. Panniculitis and lipodystrophy. Curr Opin Rheumatol 2002; 14(5): 566-70.
[http://dx.doi.org/10.1097/00002281-200209000-00015] [PMID: 12192256]
[11]
Shavit E, Marzano AV, Alavi A. Ulcerative versus non-ulcerative panniculitis: Is it time for a novel clinical approach to panniculitis? Int J Dermatol 2021; 60(4): 407-17.
[http://dx.doi.org/10.1111/ijd.15224] [PMID: 33040341]
[12]
Requena L, Sánchez Yus E. Erythema nodosum. Semin Cutan Med Surg 2007; 26(2): 114-25.
[http://dx.doi.org/10.1016/j.sder.2007.02.009] [PMID: 17544964]
[13]
Aronson IK, Worobec SM. Panniculitis. Dermatol Ther 2010; 23(4): 317-9.
[http://dx.doi.org/10.1111/j.1529-8019.2010.01331.x] [PMID: 20666818]
[14]
Iwasaki A, Medzhitov R. Regulation of adaptive immunity by the innate immune system. Science 2010; 327(5963): 291-5.
[http://dx.doi.org/10.1126/science.1183021] [PMID: 20075244]
[15]
Torrelo A. CANDLE syndrome as a paradigm of proteasome-related autoinflammation. Front Immunol 2017; 8: 927.
[http://dx.doi.org/10.3389/fimmu.2017.00927] [PMID: 28848544]
[16]
Demir S, Sag E, Dedeoglu F, Ozen S. Vasculitis in systemic autoinflammatory diseases. Front Pediatr 2018; 6: 377.
[http://dx.doi.org/10.3389/fped.2018.00377] [PMID: 30560109]
[17]
Davidson S, Steiner A, Harapas CR, Masters SL. An update on autoinflammatory diseases: Interferonopathies. Curr Rheumatol Rep 2018; 20(7): 38.
[http://dx.doi.org/10.1007/s11926-018-0748-y] [PMID: 29846818]
[18]
Ohmura K. Nakajo–Nishimura syndrome and related proteasome-associated autoinflammatory syndromes. J Inflamm Res 2019; 12: 259-65.
[http://dx.doi.org/10.2147/JIR.S194098] [PMID: 31576159]
[19]
Llamas-Velasco M, Fraga J, Sánchez-Schmidt JM, et al. Neutrophilic infiltrates in panniculitis: Comprehensive review and diagnostic algorithm proposal. Am J Dermatopathol 2020; 42(10): 717-30.
[http://dx.doi.org/10.1097/DAD.0000000000001597] [PMID: 32956080]
[20]
Tripathi SV, Leslie KS. Autoinflammatory diseases in dermatology: CAPS, TRAPS, HIDS, FMF, Blau, CANDLE. Dermatol Clin 2013; 31(3): 387-404.
[http://dx.doi.org/10.1016/j.det.2013.04.005] [PMID: 23827243]
[21]
Stolberg NG, Verbsky JW. Autoinflammatory disorders with perinatal onset. Clin Perinatol 2020; 47(1): 41-52.
[http://dx.doi.org/10.1016/j.clp.2019.10.007] [PMID: 32000928]
[22]
Canna SW, Goldbach-Mansky R. New monogenic autoinflammatory diseases—a clinical overview. Semin Immunopathol 2015; 37(4): 387-94.
[http://dx.doi.org/10.1007/s00281-015-0493-5] [PMID: 25963521]
[23]
Verbsky JW. When to suspect autoinflammatory/recurrent fever syndromes. Pediatr Clin North Am 2017; 64(1): 111-25.
[http://dx.doi.org/10.1016/j.pcl.2016.08.008] [PMID: 27894439]
[24]
Manthiram K, Zhou Q, Aksentijevich I, Kastner DL. The monogenic autoinflammatory diseases define new pathways in human innate immunity and inflammation. Nat Immunol 2017; 18(8): 832-42.
[http://dx.doi.org/10.1038/ni.3777] [PMID: 28722725]
[25]
Abramovits W, Oquendo M. Introduction to autoinflammatory syndromes and diseases. Dermatol Clin 2013; 31(3): 363-85.
[http://dx.doi.org/10.1016/j.det.2013.04.010] [PMID: 23827242]
[26]
Kanazawa N. Nakajo-Nishimura syndrome: An autoinflammatory disorder showing pernio-like rashes and progressive partial lipodystrophy. Allergol Int 2012; 61(2): 197-206.
[http://dx.doi.org/10.2332/allergolint.11-RAI-0416] [PMID: 22441638]
[27]
Poli MC. New autoinflammatory diseases. Curr Opin Pediatr 2018; 30(6): 837-47.
[http://dx.doi.org/10.1097/MOP.0000000000000696] [PMID: 30320618]
[28]
Mégarbané A, Sanders A, Chouery E, Delague V, Medlej-Hashim M, Torbey P-H. An unknown autoinflammatory syndrome associated with short stature and dysmorphic features in a young boy. J Rheumatol 2002; 29(5): 1084-7.
[PMID: 12022327]
[29]
Aksentijevich I, McDermott MF. Lessons from characterization and treatment of the autoinflammatory syndromes. Curr Opin Rheumatol 2017; 29(2): 187-94.
[http://dx.doi.org/10.1097/BOR.0000000000000362] [PMID: 27906774]
[30]
Morita TCAB, Trés GFS, García MSC, Halpern I, Criado PR, de Carvalho JF. Panniculitides of particular interest to the rheumatologist. Adv Rheumatol 2019; 59(1): 35.
[http://dx.doi.org/10.1186/s42358-019-0077-5] [PMID: 31370889]
[31]
Blake T, Manahan M, Rodins K. Erythema nodosum - a review of an uncommon panniculitis. Dermatol Online J 2014; 20(4): 22376.
[http://dx.doi.org/10.5070/D3204022376] [PMID: 24746312]
[32]
Requena L, Yus ES. Panniculitis. Part I. Mostly septal panniculitis. J Am Acad Dermatol 2001; 45(2): 163-86.
[http://dx.doi.org/10.1067/mjd.2001.114736] [PMID: 11464178]
[33]
Chowaniec M, Starba A, Wiland P. Erythema nodosum – review of the literature. Reumatologia 2016; 54(2): 79-82.
[http://dx.doi.org/10.5114/reum.2016.60217] [PMID: 27407284]
[34]
Shiau CJ, Abi Daoud MS, Wong SM, Crawford RI. Lymphocytic panniculitis: An algorithmic approach to lymphocytes in subcutaneous tissue. J Clin Pathol 2015; 68(12): 954-62.
[http://dx.doi.org/10.1136/jclinpath-2014-202849] [PMID: 26602413]
[35]
Yazici H, Seyahi E, Hatemi G, Yazici Y. Behçet syndrome: A contemporary view. Nat Rev Rheumatol 2018; 14(2): 107-19.
[http://dx.doi.org/10.1038/nrrheum.2017.208] [PMID: 29296024]
[36]
Flynn S, Eisenstein S. Inflammatory bowel disease presentation and diagnosis. Surg Clin North Am 2019; 99(6): 1051-62.
[http://dx.doi.org/10.1016/j.suc.2019.08.001] [PMID: 31676047]
[37]
Requena L, Yus ES. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol 2001; 45(3): 325-64.
[http://dx.doi.org/10.1067/mjd.2001.114735] [PMID: 11511831]
[38]
Llanos O, Hamzeh N. Sarcoidosis. Med Clin North Am 2019; 103(3): 527-34.
[http://dx.doi.org/10.1016/j.mcna.2018.12.011] [PMID: 30955519]
[39]
Mana J, Marcoval J. Erythema nodosum. Clin Dermatol 2007; 25(3): 288-94.
[http://dx.doi.org/10.1016/j.clindermatol.2007.03.006] [PMID: 17560306]
[40]
Pasqualini C, Jorini M, Carloni I, Giangiacomi M, Cetica V, Aricò M. Cytophagic histiocytic panniculitis, hemophagocytic lymphohistiocytosis and undetermined autoimmune disorder: Reconciling the puzzle. Ital J Pediatr 2014; 40(1): 17.
[http://dx.doi.org/10.1186/1824-7288-40-17]
[41]
Aronson IK, Worobec SM. Cytophagic histiocytic panniculitis and hemophagocytic lymphohistiocytosis: An overview. Dermatol Ther 2010; 23(4): 389-402.
[http://dx.doi.org/10.1111/j.1529-8019.2010.01339.x] [PMID: 20666826]
[42]
Krilis M, Miyakis S. Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature. Mod Rheumatol 2012; 22(1): 158-62.
[http://dx.doi.org/10.3109/s10165-011-0487-7] [PMID: 21732050]
[43]
Hilton DA, O’Malley BP, Durrant STS. Histiocytic cytophagic panniculitis. Postgrad Med J 1990; 66(781): 958-61.
[http://dx.doi.org/10.1136/pgmj.66.781.958] [PMID: 2267213]
[44]
Alegre VA, Winkelmann RK. Histiocytic cytophagic panniculitis. J Am Acad Dermatol 1989; 20(2): 177-85.
[http://dx.doi.org/10.1016/S0190-9622(89)70018-9] [PMID: 2644315]
[45]
Chen RL, Hsu YH, Ueda I, et al. Cytophagic histiocytic panniculitis with fatal haemophagocytic lymphohistiocytosis in a paediatric patient with perforin gene mutation. J Clin Pathol 2007; 60(10): 1168-9.
[http://dx.doi.org/10.1136/jcp.2007.049551] [PMID: 17601962]
[46]
Morrison LK, Rapini R, Willison CB, Tyring S. Infection and panniculitis. Dermatol Ther 2010; 23(4): 328-40.
[http://dx.doi.org/10.1111/j.1529-8019.2010.01333.x] [PMID: 20666820]
[47]
Rotondo C, Corrado A, Mansueto N, Cici D, Corsi F, Pennella A. Pfeifer-weber-christian disease: A case report and review of literature on visceral involvements and treatment choices. Clin Med Insights Case Rep 2020; 13: 1179547620917958.
[http://dx.doi.org/10.1177/1179547620917958]
[48]
Lipsker D, Perrigouard C, Foubert A, Cribier B. Anakinra for difficult-to-treat neutrophilic panniculitis: IL-1 blockade as a promising treatment option for neutrophil-mediated inflammatory skin disease. Dermatology 2010; 220(3): 264-7.
[http://dx.doi.org/10.1159/000280436] [PMID: 20197651]

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