Neutrophilic Lobular Panniculitis

Neutrophilic lobular panniculitis is a type of skin condition characterized by the presence of neutrophils, a type of white blood cell, within the fat cells of the skin. This condition can present as a variety of skin eruptions, ranging from mild to severe. The exact cause of neutrophilic lobular panniculitis is not well understood, but it is believed to be related to a variety of underlying medical conditions, including autoimmune diseases, infections, and certain medications.

There are several different types of neutrophilic lobular panniculitis, including:

1. Erythema Nodosum: This is the most common form of neutrophilic lobular panniculitis, characterized by the appearance of tender, red, raised nodules on the legs. The nodules may be accompanied by swelling and warmth, and can be painful to the touch. Erythema nodosum is often associated with underlying infections, such as streptococcal pharyngitis, or with certain medications, such as birth control pills.
2. Erythema Induratum: This type of neutrophilic lobular panniculitis is characterized by the appearance of deep, purplish nodules on the legs, which may be painful and tender. Erythema induratum is often associated with tuberculosis, and may also be related to other underlying medical conditions, such as autoimmune diseases.
3. Subcutaneous Nodular Panniculitis: This type of neutrophilic lobular panniculitis is characterized by the appearance of firm, subcutaneous nodules, which may be tender and painful. Subcutaneous nodular panniculitis is often associated with certain autoimmune diseases, such as rheumatoid arthritis, and may also be related to certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
4. Panniculitis Liked to Cancer: This type of neutrophilic lobular panniculitis is characterized by the appearance of firm, subcutaneous nodules, which may be tender and painful. Panniculitis linked to cancer is often associated with underlying malignancies, such as lymphomas or leukemias.

Causes

The exact cause of neutrophilic lobular panniculitis is not well understood, and it can be difficult to determine the underlying cause in many cases. However, a number of potential triggers have been identified, including:

1. Infections: Bacterial, fungal, and viral infections can all trigger an immune response that leads to the infiltration of neutrophils into the subcutaneous fat tissue. Some of the most commonly implicated infections include streptococcal infections, staphylococcal infections, tuberculosis, and Lyme disease.
2. Autoimmune disorders: Some autoimmune disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren’s syndrome, have been linked to neutrophilic lobular panniculitis. In these cases, the immune system mistakenly attacks the body’s own tissues, leading to inflammation and tissue damage.
3. Drug reactions: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and penicillins, can trigger an immune response that leads to neutrophilic lobular panniculitis. In some cases, the reaction is due to a true drug allergy, while in others it is due to an idiosyncratic reaction to the drug.
4. Inflammatory bowel disease: Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, can trigger an immune response that leads to neutrophilic lobular panniculitis. In these cases, the inflammation in the gut is thought to spread to other parts of the body, including the subcutaneous fat tissue.
5. Malignancy: Some types of cancer, such as Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and leukemia, have been linked to neutrophilic lobular panniculitis. In these cases, the cancer cells themselves are thought to trigger the immune response that leads to the infiltration of neutrophils into the subcutaneous fat tissue.
6. Vasculitis: Vasculitis is a condition in which the blood vessels become inflamed, and it can lead to neutrophilic lobular panniculitis. Some of the most commonly implicated forms of vasculitis include Wegener’s granulomatosis, Churg-Strauss syndrome, and polyarteritis nodosa.
7. Infectious mononucleosis: Infectious mononucleosis, also known as “mono,” is a viral illness that is caused by the Epstein-Barr virus. It has been linked to neutrophilic lobular panniculitis in some cases.
8. Connective tissue diseases: Some connective tissue diseases, such as dermatomyositis and scleroderma, have been linked to neutrophilic lobular panniculitis. In these cases, the immune system mistakenly attacks the connective tissue in the skin and subcutaneous fat tissue.
9. Human immunodeficiency virus (HIV): HIV, the virus that causes AIDS, can weaken the immune system and make individuals more susceptible to neutrophilic lobular panniculitis. In some cases, the condition may be triggered by an opportunistic infection that takes advantage of the weakened immune system.
10. Inflammatory skin diseases: Some inflammatory skin diseases, such as psoriasis and eczema, have been linked to neutrophilic lobular panniculitis.

Symptoms

The following are the common symptoms associated with neutrophilic lobular panniculitis:

1. Red and swollen lumps under the skin: The most noticeable symptom of neutrophilic lobular panniculitis is the formation of red, swollen lumps under the skin. These lumps are usually painful and can range in size from a few millimeters to several centimeters in diameter.
2. Tenderness: The lumps associated with neutrophilic lobular panniculitis are often tender to the touch. This tenderness can be severe and may be accompanied by a burning or stinging sensation.
3. Warmth: The skin over the lumps may feel warm to the touch due to increased blood flow to the area. This warmth can also be a sign of inflammation.
4. Skin discoloration: In some cases, the skin over the lumps may appear reddish or purplish. This discoloration can be a sign of an underlying skin infection or other underlying medical condition.
5. Skin thinning: Over time, the lumps associated with neutrophilic lobular panniculitis can cause the skin to thin and become fragile. This thinning can be noticeable, especially in areas where the lumps are located.
6. Nodules: Some people with neutrophilic lobular panniculitis may develop nodules, which are small, firm lumps that are attached to the underlying tissue.
7. Abscesses: In some cases, the lumps associated with neutrophilic lobular panniculitis may become infected, leading to the formation of abscesses. These abscesses can be painful and may require drainage.
8. Blisters: Some people with neutrophilic lobular panniculitis may develop blisters, which are fluid-filled pockets that form under the skin. Blisters can be painful and may burst, leading to further skin irritation and infection.
9. Crusting: The skin over the lumps may become dry and scaly, leading to the formation of crusts. These crusts can be unsightly and may cause discomfort or itching.
10. Ulceration: In some cases, the lumps associated with neutrophilic lobular panniculitis may ulcerate, meaning that the skin over the lumps breaks down and becomes an open wound.
11. Scarring: Over time, the lumps associated with neutrophilic lobular panniculitis can cause scarring, which can be permanent and disfiguring.
12. Itching: The skin over the lumps may be itchy, which can be uncomfortable and distracting.
13. Pain: The lumps associated with neutrophilic lobular panniculitis can be painful, especially when they are touched or bumped.
14. Fatigue: Some people with neutrophilic lobular panniculitis may experience fatigue, which can be related to the underlying inflammation and infection.
15. Weight loss: In some cases, people with neutrophilic lobular panniculitis may experience weight loss, which can be related to the underlying inflammation and infection.

Diagnosis

Diagnosis of neutrophilic lobular panniculitis typically involves a combination of clinical examination, laboratory tests, and imaging studies. The following is a list of 20 tests and diagnoses that may be used in the evaluation of this condition:

1. Clinical examination: A thorough physical examination is the first step in diagnosing neutrophilic lobular panniculitis. The doctor will look for characteristic symptoms, such as red, tender, and swollen lumps in the subcutaneous fat layer.
2. Biopsy: A skin biopsy is often necessary to confirm the diagnosis of neutrophilic lobular panniculitis. This procedure involves removing a small sample of affected skin for examination under a microscope. The biopsy will reveal the characteristic inflammation and infiltration of neutrophils in the subcutaneous fat layer.
3. Complete blood count (CBC): A CBC is a routine blood test that measures the number and types of cells in the blood. An elevated white blood cell count can suggest inflammation or infection and may be seen in patients with neutrophilic lobular panniculitis.
4. Erythrocyte sedimentation rate (ESR): The ESR is a blood test that measures the rate at which red blood cells settle to the bottom of a test tube. An elevated ESR is often seen in patients with inflammation and may be seen in patients with neutrophilic lobular panniculitis.
5. C-reactive protein (CRP) test: CRP is a protein produced by the liver in response to inflammation. A CRP test can help to determine the presence and severity of inflammation in the body.
6. Antinuclear antibody (ANA) test: The ANA test is used to detect the presence of antibodies directed against components of the nucleus of cells. A positive ANA test can suggest the presence of an autoimmune disorder, such as lupus, which can cause neutrophilic lobular panniculitis.
7. Rheumatoid factor (RF) test: The RF test is used to detect the presence of antibodies directed against the protein, rheumatoid factor. A positive RF test can suggest the presence of rheumatoid arthritis, which can cause neutrophilic lobular panniculitis.
8. HLA-B27 antigen test: The HLA-B27 antigen test is used to detect the presence of a genetic marker that is associated with an increased risk of developing certain autoimmune disorders, including ankylosing spondylitis, which can cause neutrophilic lobular panniculitis.
9. Serum protein electrophoresis (SPEP): The SPEP test is a blood test that measures the levels of different proteins in the blood. An elevated level of a protein called immunoglobulin A (IgA) can suggest the presence of an autoimmune disorder, such as IgA nephropathy, which can cause neutrophilic lobular panniculitis.
10. Computed tomography (CT) scan: A CT scan is a type of imaging test that uses X-rays and computer processing to produce detailed images of the body. A CT scan can help to determine the extent of the inflammation and to identify any underlying causes, such as infections

Treatment

References