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Panniculitis: recent developments and observations
W L White1, J S Wieselthier, M G Hitchcock
1Department of Pathology, North Carolina Baptist Hospital, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, USA.
Abstract:
Dermatopathologists rarely greet a biopsy of panniculitis with total confidence that a specific, definitive diagnosis will be rendered. As with many other areas in dermatopathology, our understanding of the pathogenesis of many forms of panniculitis is incomplete. This article examines a subset of panniculitis primarily from a pathogenetic standpoint, with the intention of providing a differential diagnosis for those cases in which ischemic changes are seen in the subcutis. The diverse group of conditions evoked by this approach also shares the distinction of having been the focus of nosologic and causative controversy, both historically and currently. In particular, stasis-associated sclerosing panniculitis, vascular calcification-cutaneous necrosis syndrome (calciphylaxis), oxalosis, and nodular vasculitis-erythema induratum are examined in depth. Erythema nodosum and variants, other granulomatous panniculitides, and panniculitides showing cytophagocytosis are also discussed with current perspectives.
Insights
Diagnosing panniculitis can be challenging due to incomplete understanding of its causes. This review focuses on ischemic changes in the subcutis, aiding dermatopathologists in differential diagnosis for conditions like calciphylaxis and nodular vasculitis.
Area of Science:
- Dermatopathology
- Pathogenesis of inflammatory skin conditions
Background:
- Panniculitis diagnosis is often uncertain, with incomplete understanding of its pathogenesis.
- Ischemic changes in the subcutis present diagnostic challenges for dermatopathologists.
Purpose of the Study:
- To provide a pathogenetic-based differential diagnosis for panniculitis with ischemic subcutis changes.
- To clarify nosologic and causative controversies surrounding specific panniculitis subtypes.
Main Methods:
- Review of literature focusing on pathogenetic mechanisms of panniculitis.
- In-depth examination of specific conditions including stasis-associated sclerosing panniculitis, calciphylaxis, oxalosis, and nodular vasculitis-erythema induratum.
- Discussion of erythema nodosum, granulomatous panniculitides, and cytophagocytic panniculitides.
Main Results:
- Identifies key panniculitis entities associated with ischemic subcutis changes.
- Highlights historical and current controversies in the classification and etiology of these conditions.
- Provides current perspectives on erythema nodosum variants and other panniculitis types.
Conclusions:
- A pathogenetic approach aids in diagnosing panniculitis with ischemic features.
- Understanding the diverse etiologies and controversies is crucial for accurate diagnosis.
- Further research into panniculitis pathogenesis is warranted.