Overview
Lupus panniculitis, often associated with systemic lupus erythematosus (SLE), involves inflammation of subcutaneous fat tissue, presenting as nodules or indurations, typically affecting the face, neck, and extremities. 1Diagnosis
Clinical Presentation: Symmetrical nodules, often on lower and upper extremities.
Serological Tests: Elevated ANA, anti-dsDNA antibodies, and complement levels may be indicative.
Imaging: CT scans can help rule out other causes and assess extent of involvement.
Histological Examination: Characteristic histopathological features include septal panniculitis with lymphocytic infiltration.
Immunohistochemistry: Useful for confirming immune complex deposition and cellular infiltrates.
Differential Diagnosis: Exclude other causes like infections, malignancies, and other forms of panniculitis through comprehensive evaluation. 1Management
First-Line Treatments:
- Corticosteroids: High-dose systemic corticosteroids for acute presentations.
- Antimalarials: Hydroxychloroquine as adjunctive therapy to reduce inflammation.
Adjunctive Treatments:
- Immunosuppressants: Azathioprine or mycophenolate mofetil for refractory cases.
- Biologics: TNF inhibitors or rituximab considered in severe, resistant forms. 1Special Populations
Pregnancy: Management requires careful consideration to avoid teratogenic effects; close monitoring and possibly dose adjustments of immunosuppressants are necessary. 1
Elderly: Increased risk of comorbidities; treatment should be tailored to minimize side effects while controlling disease activity. 1
Comorbidities: Presence of underlying diseases (e.g., secondary panniculitis) necessitates addressing these conditions concurrently to optimize outcomes. 1Key Recommendations
Comprehensive Evaluation: Include serological tests, imaging, and histopathological examination for accurate diagnosis (Evidence: Moderate) 1
Initial Treatment with Corticosteroids: High-dose systemic corticosteroids are recommended for acute presentations of lupus panniculitis (Evidence: Moderate) 1
Adjunctive Use of Antimalarials: Hydroxychloroquine should be considered as adjunctive therapy to manage chronic inflammation (Evidence: Moderate) 1References
1 Savushkina NM, Egorova ON, Glukhova SI, Belov BS. Panniculitis in rheumatology: features of course and outcomes. Terapevticheskii arkhiv 2018. link