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Panniculitis

»What is panniculitis?
»Name the various types of panniculitis. How are they classified?
»What is erythema nodosum?
»What is the pathogenesis of erythema nodosum?
»List some of the common underlying conditions associated with erythema nodosum.
»How should a biopsy of erythema nodosum be obtained?
»What are the characteristic microscopic features of erythema nodosum?
»How is erythema nodosum treated?
»What is nodular vasculitis?
»What causes nodular vasculitis?
»Describe the microscopic features of nodular vasculitis.
»What is the differential diagnosis of nodular vasculitis?
»How should nodular vasculitis be treated?
»What are the clinical features of lupus panniculitis?
»Describe the microscopic features of lupus panniculitis.
»What is the significance of diagnosing lupus panniculitis?
»Are sclerema neonatorum and subcutaneous fat necrosis of the newborn the same thing?
»How similar are the microscopic features of sclerema neonatorum and subcutaneous fat necrosis of the newborn?
»Why do these disorders occur in neonates and infants?
»What is pancreatic fat necrosis?
»Are there any characteristic histopathologic features of pancreatic fat necrosis?
»What is the role of a-1 antitrypsin deficiency in the development of panniculitis?
»Name some types of trauma that can produce panniculitis.
»Which infectious organisms can produce panniculitis?
»Describe the role of malignancy in producing panniculitis.
»What is lipodystrophy?
»What is lipoatrophy?
»What is lipohypertrophy?
»Discuss the approach to use when attempting to diagnose an “unknown” case of panniculitis.

 
 
 

What is lipohypertrophy?

Lipohypertrophy, which manifests as induration of involved skin, occurs in some individuals due to repeated injections of insulin. This effect is apparently independent of the source of insulin, and can even occur with human recombinant insulin. Growth hormone injections have also resulted in lipohypertrophy. In lipohypertrophy, lipocytes are enlarged and appear to encroach upon the midportion of the dermis. Rotation of insulin injection sites is a key to management of lipohypertrophy, both to prevent or minimize the hypertrophic changes and to assure adequate insulin absorption.

Chernausek SD, Backeljauw PF, Frane J, et al: Long-term treatment with recombinant insulin-like growth factor (IGF)-I in children with severe IGF-I deficiency due to growth hormone insensitivity, J Clin Endocrinol Metab 92:902–910, 2007. Chowdhury TA, Escudier V: Poor glycemic control caused by insulin-induced lipohypertrophy, Br Med J 327:383–384, 2003.