Septal Panniculitis

Septal panniculitis is a term used to describe a group of skin conditions that involve inflammation of the subcutaneous fat and connective tissue in the nasal septum. The nasal septum is the partition that separates the left and right nasal cavities and is composed of cartilage, bone, and soft tissue. Septal panniculitis can lead to changes in the normal anatomy of the nasal septum, causing functional and cosmetic issues.

There are several types of septal panniculitis, each with its unique set of symptoms and causes. Here is a list of the most common types of septal panniculitis:

  1. Wegener’s granulomatosis (WG)
  2. Necrobiotic xanthogranuloma (NXG)
  3. Rosai-Dorfman disease (RDD)
  4. Rheumatoid nodules
  5. Tufted angioma (TA)
  6. SAPHO syndrome
  7. IgG4-related disease
  8. Wegener’s granulomatosis (WG): Wegener’s granulomatosis is a rare autoimmune disease that affects the blood vessels and causes inflammation in various organs, including the skin and nasal septum. In WG, the immune system mistakenly attacks the body’s own tissues, leading to the formation of granulomas (clumps of immune cells) in the affected areas. In the nasal septum, granulomas can cause panniculitis, leading to septal perforation and nasal obstruction. Other symptoms of WG include sinusitis, ear infections, joint pain, and respiratory problems.
  9. Necrobiotic xanthogranuloma (NXG): Necrobiotic xanthogranuloma is a rare skin condition that is characterized by yellowish-orange papules and nodules that typically affect the face, eyelids, and ears. In some cases, the nasal septum may also be affected, leading to septal panniculitis. NXG is associated with elevated levels of a protein called paraprotein, which can be found in the blood and urine of affected individuals. The exact cause of NXG is unknown, but it is thought to be related to an autoimmune process.
  10. Rosai-Dorfman disease (RDD): Rosai-Dorfman disease is a rare condition that is characterized by the accumulation of abnormal cells in the lymph nodes and other tissues, including the skin. In some cases, the nasal septum can be affected, leading to septal panniculitis. RDD is usually asymptomatic, but in some cases, it can cause skin lesions, fever, and enlarged lymph nodes. The exact cause of RDD is unknown, but it is thought to be related to an abnormal immune response.
  11. Rheumatoid nodules: Rheumatoid nodules are firm, round lumps that form under the skin in people with rheumatoid arthritis (RA). In some cases, these nodules can also develop in the nasal septum, leading to septal panniculitis. Rheumatoid nodules are caused by the abnormal accumulation of immune cells in the affected areas and are thought to be a result of the chronic inflammation that occurs in RA.
  12. Tufted angioma (TA): Tufted angioma is a rare benign vascular tumor that typically affects children and young adults. It is characterized by the presence of red or purple papules or nodules that

Causes

The exact cause of septal panniculitis is not well understood, but there are a number of factors that have been identified as contributing to its development. Here is a list of potential causes for septal panniculitis:

  1. Trauma: Physical trauma to the nose, such as a broken nose or repeated blunt force injuries, can cause inflammation and fibrosis of the septal tissues.
  2. Infection: Bacterial, viral, or fungal infections can cause inflammation and thickening of the septal tissues, leading to septal panniculitis.
  3. Allergic reactions: Allergic reactions to substances such as pollen, dust mites, or animal dander can cause inflammation and fibrosis of the septal tissues.
  4. Autoimmune disorders: Autoimmune disorders, such as lupus or rheumatoid arthritis, can cause inflammation and fibrosis of the septal tissues.
  5. Immune system disorders: Disorders of the immune system, such as HIV or AIDS, can cause inflammation and fibrosis of the septal tissues.
  6. Medications: Certain medications, such as steroids or chemotherapy drugs, can cause inflammation and fibrosis of the septal tissues.
  7. Exposure to environmental toxins: Exposure to environmental toxins, such as tobacco smoke or air pollution, can cause inflammation and fibrosis of the septal tissues.
  8. Genetics: Some people may have a genetic predisposition to septal panniculitis, which can be triggered by environmental factors.
  9. Nutritional deficiencies: Nutritional deficiencies, such as a lack of vitamin C or zinc, can weaken the tissues and make them more susceptible to inflammation and fibrosis.
  10. Hormonal imbalances: Hormonal imbalances, such as hypothyroidism or menopause, can cause inflammation and fibrosis of the septal tissues.
  11. Stress: Chronic stress can weaken the tissues and make them more susceptible to inflammation and fibrosis.
  12. Alcohol consumption: Heavy alcohol consumption can cause inflammation and fibrosis of the septal tissues.
  13. Smoking: Smoking can cause inflammation and fibrosis of the septal tissues due to the exposure to toxic chemicals in tobacco smoke.
  14. Poor hygiene: Poor hygiene, such as not washing the nose regularly, can allow bacteria and other pathogens to flourish, leading to infection and inflammation.
  15. Dehydration: Dehydration can cause the tissues to become dry and brittle, making them more susceptible to injury and inflammation.
  16. Sun exposure: Excessive sun exposure can cause damage to the tissues and make them more susceptible to inflammation and fibrosis.
  17. Poor posture: Poor posture, such as slouching or hunching over, can put pressure on the tissues of the nose and cause injury and inflammation.
  18. Aging: The tissues of the nose naturally weaken and become more susceptible to injury and inflammation as we age.
  19. Hormonal changes during pregnancy: Hormonal changes during pregnancy can cause the tissues of the nose to become more susceptible to injury and inflammation.
  20. Rhinitis medicamentosa: Chronic use of over-the-counter decongestant nasal sprays can cause rebound congestion and inflammation of the septal tissues.

Symptoms

Symptoms associated with septal panniculitis:

  1. Painful lumps or nodules in the nasal septum: The primary symptom of septal panniculitis is the formation of painful lumps or nodules in the nasal septum. These lumps may be red, inflamed, and tender to the touch.
  2. Swelling: The lumps in the nasal septum can cause swelling in the affected area.
  3. Nasal obstruction: The swelling and lumps in the nasal septum can obstruct the airflow through the nose, making it difficult to breathe.
  4. Discharge: Some patients may experience a discharge from the affected area.
  5. Itching: The lumps or nodules in the nasal septum can be itchy.
  6. Headache: The inflammation and swelling in the nasal septum can cause headache.
  7. Fatigue: Some patients may experience fatigue as a result of the pain and discomfort associated with septal panniculitis.
  8. Loss of appetite: The pain and discomfort associated with septal panniculitis can lead to a loss of appetite.
  9. Weight loss: The loss of appetite can result in weight loss.
  10. Nausea: Some patients may experience nausea as a result of the pain and discomfort associated with septal panniculitis.
  11. Vomiting: Some patients may experience vomiting as a result of the pain and discomfort associated with septal panniculitis.
  12. Fever: In some cases, septal panniculitis can cause a low-grade fever.
  13. Night sweats: Some patients may experience night sweats as a result of the inflammation and swelling associated with septal panniculitis.
  14. Chills: Some patients may experience chills as a result of the inflammation and swelling associated with septal panniculitis.
  15. Muscle aches: Some patients may experience muscle aches as a result of the pain and discomfort associated with septal panniculitis.
  16. Joint pain: Some patients may experience joint pain as a result of the inflammation and swelling associated with septal panniculitis.
  17. Skin rash: Some patients may develop a skin rash in the affected area.
  18. Redness: The affected area may be red due to the inflammation and swelling associated with septal panniculitis.
  19. Warmth: The affected area may feel warm to the touch due to the inflammation and swelling associated with septal panniculitis.
  20. Scarring: In some cases, the lumps or nodules in the nasal septum can cause scarring.

It is important to note that not all patients with septal panniculitis will experience all of these symptoms. The severity and specific symptoms experienced can vary greatly from one patient to another.

Diagnosis

Here is a list of diagnosis and tests for septal panniculitis:

  1. Clinical examination: The first and foremost step in diagnosing septal panniculitis is a thorough clinical examination of the affected area by a dermatologist or a specialist. The examination includes observing the appearance, size, and location of the nodules or plaques, and assessing the extent of the involvement of the septal fat.
  2. Biopsy: A biopsy is the removal of a small sample of skin or tissue for examination under a microscope. It is an important diagnostic tool for septal panniculitis and is used to confirm the diagnosis and rule out other skin conditions.
  3. Hormonal evaluation: Hormonal imbalances can sometimes be a contributing factor in the development of septal panniculitis, and a hormonal evaluation may be performed to determine if hormonal therapy is necessary.
  4. Blood tests: Blood tests are used to evaluate the patient’s overall health and to rule out any underlying medical conditions that may be contributing to the development of septal panniculitis. These tests may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP).
  5. Rheumatologic tests: Rheumatologic tests are used to evaluate the patient’s immune system and to rule out any underlying autoimmune diseases that may be contributing to the development of septal panniculitis. These tests may include antinuclear antibody (ANA) test, anti-dsDNA antibody test, and rheumatoid factor (RF) test.
  6. Infectious disease tests: Infectious diseases can sometimes be a contributing factor in the development of septal panniculitis, and tests may be performed to rule out any underlying infections. These tests may include blood culture, tuberculosis skin test, and hepatitis B and C serology.
  7. Computed tomography (CT) scan: A CT scan is a type of X-ray that produces detailed images of the body’s internal structures. It is used to evaluate the extent of involvement of the septal fat and to rule out any underlying medical conditions that may be contributing to the development of septal panniculitis.
  8. Magnetic resonance imaging (MRI) scan: An MRI scan is a type of imaging test that uses strong magnetic fields and radio waves to produce detailed images of the body’s internal structures. It is used to evaluate the extent of involvement of the septal fat and to rule out any underlying medical conditions that may be contributing to the development of septal panniculitis.
  9. Ultrasound: Ultrasound is a type of imaging test that uses high-frequency sound waves to produce images of the body’s internal structures. It is used to evaluate the extent of involvement of the septal fat and to rule out any underlying medical conditions that may be contributing to the development of septal panniculitis.

Treatment

Diagnoses and tests can be used to diagnose and evaluate septal panniculitis.

  1. Physical Examination: A physical examination is the first step in diagnosing septal panniculitis. During this examination, the healthcare provider will look for signs of swelling, redness, and tenderness in the nose.
  2. Nasal Endoscopy: A nasal endoscopy is a procedure in which a thin, flexible tube with a light and camera is inserted into the nose to visualize the interior of the nasal passages. This test can help the healthcare provider to identify any abnormalities in the septal fat pads, such as swelling or inflammation.
  3. CT Scan: A CT scan is a type of X-ray that uses computer technology to produce detailed images of the body. This test can help to visualize the septal fat pads and any other structural abnormalities in the nose.
  4. MRI Scan: An MRI scan uses a strong magnetic field and radio waves to produce images of the body. This test can help to identify any structural abnormalities in the septal fat pads and to evaluate the extent of inflammation.
  5. Biopsy: A biopsy is a procedure in which a small piece of tissue is removed from the affected area for examination under a microscope. This test can help to determine the cause of the inflammation and to rule out other medical conditions.
  6. Allergy Testing: Allergy testing can be used to determine if allergies are contributing to the development of septal panniculitis. This can be done through skin prick tests or blood tests.
  7. Complete Blood Count (CBC): A CBC is a blood test that measures the number of red and white blood cells in the blood. This test can help to determine if there is an underlying infection or autoimmune disorder contributing to the development of septal panniculitis.
  8. Erythrocyte Sedimentation Rate (ESR): The ESR test measures the rate at which red blood cells settle to the bottom of a test tube. This test can help to determine if there is inflammation in the body.
  9. C-Reactive Protein (CRP) Test: The CRP test measures the level of CRP in the blood. CRP is a protein produced by the liver in response to inflammation. This test can help to determine the extent of inflammation in the body.
  10. Rheumatoid Factor (RF) Test: The RF test measures the level of RF in the blood. RF is an antibody produced by the immune system in response to inflammation. This test can help to determine if there is an underlying autoimmune disorder contributing to the development of septal panniculitis.
  11. Antinuclear Antibody (ANA) Test: The ANA test measures the level of ANA in the blood. ANA is an antibody produced by the immune system in response to inflammation. This test can help to determine if there is an underlying autoimmune disorder contributing to the development of septal panniculitis.
  12. HLA-B27 Test: The HLA-B27 test is a genetic test that can help to determine if a person is at increased risk for developing certain

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References