Panniculitis
Panniculitis is not one disease but a diverse group of inflammatory conditions affecting the subcutaneous fat. Clinically, it shows up as deep, firm red nodules or plaques that are often painful. The underlying process is complex: an immune reaction or an infection draws inflammatory cells (neutrophils, lymphocytes, histiocytes) into the fat. Under the microscope, panniculitis is strictly divided into two main groups according to where the inflammation is centered: septal panniculitis, typified by erythema nodosum, and lobular panniculitis, such as erythema induratum (Bazin disease) and pancreatic panniculitis. Whether or not vasculitis is also present is an important pointer toward the systemic cause.
At Haute-Derma, we approach panniculitis with a rigorous, evidence-based mindset. The subcutaneous fat supports and shapes the contours of the face and body, so controlling the acute inflammation early and pinning down the root cause are crucial. This stops fat necrosis from progressing and keeps disfiguring complications such as deep atrophic dents and post-inflammatory hyperpigmentation (PIH) to a minimum.
Our Specialist Approach to Managing Panniculitis
Because the inflammation sits deep in the tissue, our protocol follows strict clinical principles:
- Broad screening for systemic causes: a thorough workup to rule out triggers such as autoimmune disease (lupus, vasculitis), infection (tuberculosis, streptococci), enzyme deficiency (alpha-1 antitrypsin) and pancreatic disease.
- No heat-based or mechanical treatments during the acute phase: radiofrequency, focused ultrasound, massage and acupuncture are not used on inflamed fat, to avoid setting off a chain reaction of fat necrosis.
- Volume preservation strategy: the priority is to shut down inflammation as quickly as possible to protect the healthy fat lobules and prevent fibrosis and sunken scars beneath the skin.
Screening and Histopathologic Diagnosis at Haute-Derma
Because the lesions lie deep beneath the dermis, diagnosis at Haute-Derma relies on specialized tests:
- Clinical mapping: we record where the nodules are, how many there are and what they feel like. Nodules on the front of the shins point toward erythema nodosum (septal), while nodules on the backs of the calves that tend to ulcerate and scar point toward erythema induratum (lobular).
- Deep incisional/excisional biopsy: this is mandatory. We do not rely on a standard shallow punch biopsy because it does not capture enough fat. The doctor takes a deep, spindle-shaped (elliptical) sample down to the muscle fascia so that both the septa and the fat lobules are obtained intact.
- Detailed histopathology: the slides are examined under the microscope to determine:
- Where the inflammatory cells are (mainly in the connective tissue septa, or threading between the fat cells within the lobules).
- Whether Miescher microgranulomas, typical of erythema nodosum, are present.
- Signs of fat necrosis with lipophagocytosis (foamy histiocytes) or necrotizing vasculitis.
- Systemic laboratory tests: blood tests including ANA, amylase/lipase levels, alpha-1 antitrypsin level and a QuantiFERON-TB test to screen for tuberculosis.
Clinical Management and Specialist Treatment
At Haute-Derma, treatment is tailored to each stage of the disease:
- Medical treatment to suppress acute inflammation: nonsteroidal anti-inflammatory drugs (NSAIDs), potassium iodide or a short course of oral corticosteroids, depending on the biopsy result. Autoimmune forms of panniculitis are also treated with suitable immunomodulating drugs.
- Reducing mechanical load: bed rest during flares, plus compression bandages or medical compression stockings for leg lesions to improve venous return and reduce tissue swelling.
- Post-inflammatory aesthetic repair: once the inflammation has fully settled (at least 3–6 months):
- A long-pulse 1064 nm Nd:YAG laser or multi-layer light-based technology is used to clear lingering dilated red vessels and break up dark post-inflammatory pigment (PIH).
- For sunken atrophic areas where fat has been lost, we use micro-fat grafting or suitable biocompatible fillers to restore a smooth, even skin surface.
