Panniculitis

What is panniculitis?

“Panniculitis” is a term for a group of conditions that cause inflammation in the layer of fat beneath your skin. As a result, painful lumps (nodules) form. They look like small bruises. These are most common on your lower legs. 

Inflammation happens in the panniculus adiposus. This is fatty tissue within the layer of subcutaneous fat under your skin and above your muscle. It helps keep your body warm.

When symptoms happen, the pain may be so intense that it takes you out of the everyday activities that you once enjoyed. It may even affect your mental health and make you feel self-conscious, as the nodules cause visible skin discoloration.

There are a lot of reasons why inflammation occurs in this area of your body. A healthcare provider can help you find the right treatment to help you manage symptoms.

What are the types of panniculitis?

There are several types of panniculitis. Some of the most common include:

• Cold panniculitis. Cold temperature exposure causes symptoms.
• Erythema induratum. It affects your calves, sometimes after a tuberculosis diagnosis.
• Erythema nodosum. Symptoms usually affect your shins, and inflammation is occasionally chronic.
• Infectious panniculitis. A fungal or bacterial infection causes inflammation. 
• Lupus panniculitis. Lupus erythematosus causes symptoms.
• Mesenteric panniculitis. It targets adipose tissue folds (mesentery) of your small intestine and colon.
• Necrotizing panniculitis. Severe infections usually cause fat tissue death.
• Pancreatic panniculitis. An underlying pancreatic condition causes it.

Your provider may classify panniculitis as lobular or septal. Inflammation targets clusters of fat cells (lobules) in lobular panniculitis or the connective tissue structures around fat (fat septa) in septal panniculitis. Most types can be classified as either or both.

What are the symptoms of panniculitis?

Symptoms of panniculitis range in severity for each person but could include:

• Lumps (nodules) under your skin
• Nodules that are painful or tender to the touch
• Red to purple, brown or darker than your natural skin tone skin discoloration that looks like spotted bruising

Additional symptoms could include:

• Fever
• Joint and muscle pain
• Fatigue
• Nausea or vomiting

While there are many different types of panniculitis, most have similar symptoms but affect different locations on your body.

Where do symptoms of panniculitis affect my body?

Symptoms of panniculitis target the layer of fat under the skin. The most common places where you’ll notice symptoms include your:

• Legs
• Shins
• Arms

What causes panniculitis?

There are several possible causes of panniculitis. These vary by type and may include, but aren’t limited to, the following:

• Viral or bacterial infections (like HIV, tuberculosis or pneumonia)
• Physical trauma or an injury
• Cold temperature exposure
• Reaction to a medication (contraceptive pills, penicillin)
• An autoimmune condition (like lupus, Crohn’s disease or sarcoidosis)
• An underlying condition (like inflammatory bowel disease or pancreatic conditions)

What are the risk factors for panniculitis?

Panniculitis can affect anyone at any age — from babies to adults. The condition isn’t common, but some age groups are more at risk of experiencing symptoms. For example, infants and young children often receive a cold panniculitis diagnosis.

What are the side effects of panniculitis?

Side effects or complications of panniculitis vary by type but may include:

• Sores (lesions)
• Cracks on the surface of your skin (ulcerations)
• Thinning skin
• Skin hardening

These may lead to open wounds with the possibility of infections.

How is panniculitis diagnosed?

A healthcare provider will diagnose panniculitis after a physical exam. They’ll take a look at your skin to learn more about your symptoms. Your provider will also ask you questions about your medical history.

A skin biopsy confirms a diagnosis. For a skin biopsy, your provider will remove a small sample of your skin tissue and examine your skin cells under a microscope.

Additional testing might be necessary to determine the cause.

How is panniculitis treated?

Treatment varies based on the type and could include:

• Treating or managing any underlying condition that causes symptoms
• Taking medications to reduce symptoms

In addition, you can take care of yourself at home by:

• Elevating your legs (or the affected area of your body) to reduce swelling
• Avoiding strenuous physical activities while you have symptoms
• Wearing compression garments (socks or stockings) to help with pain or swelling
• Eating anti-inflammatory foods (Mediterranean diet) like whole grains, fruits and vegetables
• Not drinking large amounts of alcohol (it may trigger symptoms)

What medications treat panniculitis?

Your provider might recommend you take certain medications to relieve symptoms. Some medications that treat panniculitis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Antibiotics or antiviral medications
• Immunosuppressants (like corticosteroids)
• Dapsone or thalidomide
• Chemotherapy drugs (for severe symptoms)

Before starting a new medication, talk to your provider about the drugs and supplements you currently take. Let them know if you have any allergies. This helps your provider prescribe the right medication to prevent drug interactions. Ask them about the side effects of each medication before you start taking it.

What antibiotic is used for panniculitis?

The type of antibiotic varies based on the type of bacteria that caused the infection. For example, tetracycline may treat pneumonia. A broad-spectrum antibiotic like amoxicillin-clavulanic acid may help if the cause isn’t well known. 

Can panniculitis be prevented?

You can’t prevent all cases of panniculitis. But you can reduce your risk of having a flare-up by:

• Avoiding extremely cold temperatures
• Treating any underlying conditions that increase your risk of symptoms
• Taking care of yourself to prevent infections
• Wearing protective gear, like a helmet or knee pads, to prevent injury when performing physical activities

What can I expect if I have panniculitis?

Panniculitis is a chronic condition. This means you could have symptoms that come and go throughout your life. There isn’t a cure, but treatment is available to reduce symptoms and flare-ups. Your healthcare provider can help you manage any underlying conditions or triggers.

Does panniculitis affect the way my skin looks?

Panniculitis temporarily changes the way your skin looks, as symptoms create discolored lumps on your skin. These may go away with treatment and usually don’t leave any long-term marks on your skin.

But certain types may cause long-term changes to your skin. You might notice a dimple or dent on the affected area of your skin after it heals. Panniculitis doesn’t usually cause scarring, but scarring could happen if you injure the affected area of your skin.

How long does panniculitis last?

Your body will need time to heal after treatment begins. There’s no exact timeframe as to when you’ll feel better. But on average, symptoms usually clear up six weeks after starting treatment. You could notice symptoms of pain and swelling improve as soon as 24 hours after onset. But you might still have bumps or discolored areas of skin for several weeks.

Symptoms may come and go throughout your life. Your provider can help you manage flare-ups.

When should I see my healthcare provider?

If you have panniculitis, visit your provider if:

• Your symptoms don’t improve after a couple of weeks
• You have a fever that doesn’t go away after 24 hours
• Treatment makes your symptoms worse
• The lump on your skin turns into a wound, is very painful and leaks a white to yellow pus

What questions should I ask my provider?

You may want to ask your provider:

• What type of panniculitis caused my symptoms?
• What treatments do you recommend?
• Are there side effects of treatment?
• What should I do if I have pain?
• How can I manage my symptoms at home?