Panniculitis: causes of inflammation of the subcutaneous tissue and treatment. Panniculitis - fibrous inflammation of the subcutaneous tissues, symptoms and treatment

Inflammatory processes of soft tissues can occur in various forms and localize in the most different places. The clinical picture, however, is common manifestations. With a small depth of the process, painful edema develops with redness and elevated temperature skin. If the inflammation has gone deeper, the patient experiences bouts of fever, signs of intoxication appear. This indicates the beginning of the purulent-necrotic stage.

If there is any suspicion of inflammation of the soft tissues of the leg, you should immediately consult a doctor, since a rapidly developing inflammatory process may eventually lead to the need for amputation.

Types of leg inflammation

Inflammation is very easy to get even at home. Broken knees, bruises, scratches - typical causes development various inflammations legs. The penetration of microbes into soft tissues legs can also occur:

• with skin scratching - for example, with an allergy to insect bites;
• with fungal diseases accompanied by cracks in the skin;
• with diabetic ulcers;
• with varicose veins;
• when injecting in unsanitary conditions - for example, in cases of drug addiction;
• in case of injuries and wounds - for example, in athletes or the military;
• with the introduction of microflora from primary inflammatory foci with blood or lymph.

causative agents purulent inflammation soft tissues are pyogenic bacteria, mainly staphylococcal. On the initial stage blood microcirculation is disturbed, which is associated with damage to the tissue structure. If you do not immediately start treating inflammation of the soft tissues of the leg, edema begins, already painful, when muscle tissues bursting with accumulated fluid, and they signal this through the neuromuscular junction. In the vast majority of situations, the patient takes painkillers and forgets about the problem. Meanwhile, the inflammation turns into purulent stage when the neuromuscular connection is lost, there is no pain, but pus accumulates. There are two variants of purulent inflammation:

• Abscess. In the vernacular - an abscess. It develops in the muscles and subcutaneous tissue, has clearly defined boundaries within the purulent capsule, which is formed as defensive reaction body for infection.
• Phlegmon. Acute diffuse inflammation of the subcutaneous tissue, has no clear boundaries, easily spreads to the entire limb.

Legs are also at risk. anaerobic infections. The most common inflammation of the soft tissues of the leg associated with this type of infection:

• Erysipelas. It manifests itself in the form of blistering on the skin, redness, hemorrhages. The causative agent is streptococcus, inflammation can develop upon contact with a person affected by a streptococcal infection, for example, a sore throat. This type of inflammation in rare cases goes away on its own, but you should not count on it. Running cases erysipelas take several months to heal.
• Gangrene- necrosis of tissues. The causative agent is bacteria of the Clostridium family, "living" in soil and dust. Gangrene is treated only by amputation, so it is very important to disinfect wounds in case of injuries and immediately consult a doctor.

Methods for treating leg inflammation

Inflammatory processes are treated in several stages. If the disease has passed into a purulent stage, it is necessary surgical removal pus and wound treatment. Further and at milder stages, an anti-inflammatory drug is prescribed. drug therapy- a course of antibiotics in the form of tablets or injections, depending on the origin and severity of the infection. It is very important to choose the right drugs, for this is done bacterial culture. The patient is prescribed plentiful drink to quickly remove toxins from the body.

At the recovery stage, physiotherapy is prescribed, aimed at regenerating the circulatory system and lymph flow. It successfully copes with this, contributing to the speedy recovery of soft tissues. You can go through it in our .

Furuncle is an acute purulent-necrotic inflammation hair follicle and surrounding tissues. In the future, inflammation passes to the sebaceous gland and the surrounding connective tissue. It is caused more often by golden, less often by white staphylococcus aureus. Multiple lesions of boils are called furunculosis. Skin contamination and microtrauma predispose to the development of the disease. significant role in the occurrence of boils and furunculosis plays a weakening defensive forces body due to...

The diagnosis of an abscess is an indication for surgical intervention, the purpose of which, regardless of the localization of the process, is to open the abscess, empty and drain its cavity. Cold abscesses of tuberculous etiology are not subject to opening due to the inevitable superinfection with pyogenic flora. The previously used puncture method for treating a number of superficially located abscesses did not justify itself, since it leads to massive development ...

Used to treat erysipelas a large number of a variety of methods that affect locally and on the whole body. It used to be expected to stop the spread of the erysipelas process by cauterization healthy skin surrounding the lesion, solutions of iodine, lapis, skin infiltration antiseptic preparations. Lotions with solutions of mercury dichloride, lysoform, etc. were applied to the lesion, ointment dressings were widespread (ichthyol, naftalan ointment, ...

With boils and furunculosis, local and general treatment is indicated. Local treatment boils consists in a thorough toilet of the skin around the site of inflammation: wiping with 70 ° alcohol, 2% salicylic alcohol or lubrication 1 - 3% alcohol solution methylene blue, brilliant green, etc. On the scalp and neck, the hair around the infiltrate is carefully cut off. At the very beginning of the process, abortive ...

Phlegmon is an acute diffuse inflammation of the cellular spaces (subcutaneous, intermuscular, retroperitoneal, etc.). Unlike an abscess with phlegmon, the process is not limited, but spreads through loose cellular spaces. The causative agents of phlegmon are usually staphylococci and streptococci, but it can also be caused by other microbes that penetrate into the fiber through accidental damage skin, mucous membranes or hematogenous way. Phlegmon…

Measures aimed at preventing diseases of erysipelas and ensuring the prevention of infection from a patient with erysipelas, i.e., prevention, are reduced to the fight against contact infection. The first group includes measures for the prevention and timely treatment of microtraumas, abrasions, etc., received at work, at home, and strict adherence to personal hygiene rules. The prevention of contact infection of others is determined by strict adherence to ...

The furuncle can be solitary, but sometimes many foci of inflammation appear simultaneously or sequentially one after the other. different areas skin - the so-called furunculosis. The appearance of many boils in a limited area of ​​\u200b\u200bthe body is called local furunculosis. Sometimes the occurrence of boils in the form of multiple rashes continues with small remissions for several years. This process is called chronic, recurrent furunculosis ....

Usually clinical picture phlegmon is characterized by the rapid appearance and spread of painful swelling, diffuse reddening of the skin over it, high temperature(40 ° C and above), pain, dysfunction of the affected part of the body. The swelling is a dense infiltrate. Then it softens and a symptom of fluctuation appears. Clinical course phlegmon is rarely favorable. Malignant forms are more common, when the process progresses rapidly, capturing ...

Erysipeloid, or swine rubella - infection caused by porcine erysipelas. There are acute, chronic and recurrent forms of the disease. The most frequently affected people are directly associated with the processing of meat, fish, game, i.e. workers in the meat, fish, canning and leather industries, housewives, etc. The disease is not rare, but is often viewed or diagnosed as "erysipelas ...

Carbuncle is an acute purulent-necrotic inflammation of several hair follicles and sebaceous glands with the formation of general and extensive necrosis of the skin and subcutaneous tissue. The carbuncle is more often solitary. The causes of its occurrence are the same as the boil. Its development is facilitated by exhaustion, severe common diseases, metabolic diseases ( diabetes, obesity) and high virulence of the pathogen. The causative agents are Staphylococcus aureus or…

Panniculitis (PN) are diseases of a heterogeneous nature, which are characterized by pathological changes in subcutaneous fat (SAT). Often, these diseases also affect the musculoskeletal system.

What is the problem with diagnostics?

Mon are diverse in their clinical and morphological manifestations, there are a large number of forms of the disease, while the criteria that would lead to a common denominator in the diagnosis of this moment no. Patients with PN turn to different specialists precisely because of the polymorphism of clinical symptoms. Such situations lead to insufficiently rapid diagnosis, and in connection with this, treatment begins untimely.
Classification attempts

At present, there is no classification that would be the same for all countries of the world. Some authors offer their own vision and order Mon according to etiology and pathomorphological picture. Thus, septal (SPN) and lobular are now distinguished panniculitis(LPN), that is, an inflammatory process located in the connective tissue septa and in the lobules of adipose tissue, respectively. Both variants of the disease can be combined with the phenomena of vasculitis and proceed without it.

Erythema nodosum (UE)

UE is a typical representative of septal panniculitis. The immunoinflammatory process in this pathology is nonspecific. There are many reasons for its appearance:

Distinguish between primary and secondary UE. Primary is most often idiopathic. Clinical symptoms, which occur during RE, are characterized by the state immune system, etiology of the disease, localization of the pathological focus, as well as prevalence.

It is possible to diagnose UE only after a carefully collected anamnesis, patient complaints, on the basis of the clinic and research data, laboratory and instrumental.

Brief description of case study #1

The patient is 31 years old and has a history of chronic tonsillitis from 15 years old and frequent appointments antibiotics for him. In 2009, painful nodes were discovered after another exacerbation of tonsillitis. The knots were located on the left leg. Treatment with glucocorticosteroid hormone dexamethasone was carried out, after which a positive trend was observed. After 3 years, tonsillitis provoked the appearance of 2 more nodes on the legs. After two months of homeopathic therapy, the nodes regressed. At the end of the year, there was a recurrence of painful formations on the lower leg.

Upon admission, the general condition is satisfactory, the physique is normosthenic, the body temperature is normal. Other indicators of examination and laboratory tests were also not changed.

On palpation of the formations on the lower leg, pain is noted. Ultrasound of the node revealed an area of ​​some blurring with increased echogenicity and great content vessels.

The diagnosis made by the doctors sounded like stage 2-3 erythema nodosum and chronic tonsillitis. After treatment with benzylpenicillin, non-steroidal anti-inflammatory drugs, administration protective regime and local treatment Clobetasol sodium and heparin ointments after 21 days the disease regressed. There were no exacerbations of pathology during the year.
Of the causes of the disease in the first place with streptococcal infection 9a, the above case indicates the association of UE (septal panniculitis) with streptococcal infection, in particular, with tonsillitis) is sarcoidosis.

Case Brief #2

A 25-year-old patient was admitted to the hospital with complaints of painful nodules on the legs and arms, pain in many joints (ankle, wrist), swelling in them, fever up to 39C, excessive sweating.

She fell ill on December 7, 2013, when arthritis of the ankle joint appeared for the first time. After 2 days, nodes appeared on the legs, which were sharply painful. A few days later, a large number of the same formations appeared with symptoms of general intoxication (fever, sweating).

After examination, the therapist was diagnosed with a probable reactive arthritis. Dexamethasone was used for treatment. The effect turned out to be positive. However, relapses continued.

According to laboratory data, inflammatory changes were determined in the blood. On CT scans chest increased The lymph nodes and there were signs of chronic. On ultrasound of the node, its structure was lumpy, some areas were non-echoic and rich in vessels.

After consultation with a pulmonologist, sarcoidosis of the intrathoracic lymph nodes was exposed. The final diagnosis looked like Löfgren's syndrome, sarcoidosis of the lymph nodes of the chest at stage 1, secondary UE, polyarthritis, febrile syndrome.

The patient was treated with dexamethasone with cyclophosphamide parenterally. Then methylprednisolone was prescribed orally. Cyclophosphamide was also administered weekly, accompanied by a non-steroidal anti-inflammatory drug. The therapy led to a positive dynamics of the disease and at the moment the patient is under the supervision of doctors.

Differential diagnosis of UE

There are many diseases, the clinical picture of which is similar to the symptoms of UE, so it is necessary to conduct a thorough differential diagnosis. If differential diagnosis is carried out incorrectly or out of time, inadequate therapy is prescribed, which leads to a prolongation of the disease and the appearance of various complications and a deterioration in the quality of human life.

Example of a clinical case No. 3

A 36-year-old patient came to the hospital for medical care at the beginning of 2014 in connection with complaints of induration of the lower leg, which was painful. The patient believes that the disease first appeared in 2012 after (SARS). Then there was a painful induration on the lower leg. The doctors diagnosed thrombophlebitis. Treated with vascular medicines physiotherapy was prescribed. The patient completed the treatment with positive dynamics. In April 2013, the painful induration reappeared. were held laboratory research that showed no inflammatory changes. Ultrasound of the veins revealed insufficiency of the perforating veins of the leg. The patient was referred for a consultation at the NIIR them. V.A. Nasonova, where during the examination a seal was found on the lower leg. Laboratory and instrumental research within the normal range. On ultrasound internal organs some diffuse changes pancreas and liver. On the ultrasound of the node, microvascularization, clumpy structure and thickening of the pancreas.
After all examinations and consultations, a diagnosis of lobular panniculitis, chronic course, lipodermatosclerosis. Varicose veins veins lower extremities. Chronic venous insufficiency class IV.

Treated with hydroxychloroquine due to low disease activity. A month later, the dynamics of the disease is positive.

Discussion of specific cases

We have brought to your attention 3 different cases differential diagnosis which are currently very common.

In the first patient after streptococcal infection on the background of antibiotics and anti-inflammatory drugs, the disease regressed. Moreover, we note the color dynamics of formations on the skin: a pale red color at the beginning to a yellow-green color at the end of the disease, the so-called bruise flowering symptom.

For UE, this dynamics is very typical and even on late stages illness can be identified. The nodules themselves disappear without a trace after 3-5 weeks. Skin atrophy and scarring are not observed.
At the same time with skin manifestations manifests and articular syndrome. There are pains and swelling in the joints in half of the patients with UE. The most common lesion of the ankle joints. Regression of arthritis is observed within six months. Such patients do not develop heart disease, as in rheumatic fever, even though joint pain appears after a primary streptococcal infection.

If patients with UE have valvular pathology of the heart, it does not worsen. In this regard, we can say that UE is not a reflection of the activity of the rheumatic process.

UE and sarcoidosis

Against the background of sarcoidosis, UE has features of the course and manifestations:

• swelling of the legs, which often precedes UE;
• severe pain in the joints;
• there are a lot of elements of skin seals and they are extremely common, while each element is capable of merging with another similar node;
• localization of nodes mainly in the area of ​​​​the legs;
• the dimensions of the elements are large, more than 2 cm in diameter;
• in laboratory tests there may be an increase in the titer of antibodies to antistreptolysin-O and to Yersinia;
• Respiratory tract involvement with symptoms such as shortness of breath, chest pain, cough.

UE (septal panniculitis), hilar lymphadenopathy, fever, and joint involvement suggest Löfgren's syndrome. Despite this, enlarged lymph nodes can be

There are many ways to find out how polluted your body is. Special analyses, studies, and tests will help to carefully and purposefully identify violations of the endoecology of your body...

Diseases of the skin and subcutaneous tissue

Diseases of the skin and subcutaneous tissue:

The pathology got its name because it was first described in great detail in 1933 by the dermatologist Manganotti. This doctor noted that in such patients cheilitis manifests itself mainly in the form of skin defects on the red border of the lips, as a result of which, over time, the process almost always transforms into cancer of the lip. AT...

Actinic cheilitis is an inflammatory disease of the lips caused by hypersensitivity to UV rays. In children, the disease occurs quite often, which is associated with their prolonged exposure to the sun.

This pathology belongs to the group of so-called vascular allergies. Most often, females, especially young girls, get sick. The lesions are located on the legs, somewhat less often on the arms. Factors contributing to the development of pathology are various colds and inflammatory diseases, stagnation...

Allergic dermatitis- this is a disease that develops as a response of the patient's body to the effects of an optional stimulus (i.e., a substance to which normal healthy people allergic reactions does not develop) by direct contact with the skin for even a fairly short ...

Amyloidosis is a heterogeneous disorder of protein metabolism in which amyloid glycoprotein is deposited extracellularly in the tissues of various organs. There are systemic and local amyloidosis. With the latter, amyloid deposits are localized only in a specific organ.

A disease characterized by decreased sweat production or total absence. Basically, anhidrosis is a pathology that develops against the background of other skin diseases most often of a hereditary nature.

This disease is characterized increased dryness skin. Sebum is not secreted from the sebaceous glands at all or is secreted in small quantities.

Atheromas are cystic-dilated cutaneous sebaceous glands. Congenital and secondary varieties of atheromas are distinguished by origin. Congenital atheromas are benign tumors skin. They are located in the form of multiple formations, their size is from lentil grain and more. Most often...

Basaliomas occupy an intermediate position among skin tumors. They have predominantly locally destructive growth, do not give metastases. Paches A.I., 1863; Glazunov M.F., 1933 believe that basaliomas arise from the embryonic ectoderm along the line of embryonic face closures. Among the embryonic skin tumors of the region...

Basalioma is one of the most common skin tumors (60-80% of all malignant tumors skin). Most often, basalioma occurs over the age of 50 years. Typical localization - face (forehead, nose, inner corner of the eye, nasolabial fold), neck.

White piedra (knotty trichosporia) is an anthroponotic mycotic lesion of the hair cuticle. The disease is more often recorded in countries with a warm or tropical climate. In persons with immunodeficiencies, fungemia is possible with the development of endophthalmitis, brain abscesses, endocarditis, etc.

Warty tuberculosis of the skin - this disease is more common in adults, and males are noticeably more at risk of getting sick. In the bulk, the disease is associated with the nature of the profession and affects people working with tuberculous material from the corpses of animals and people: veterinarians, butchers, ...

It is an easily flowing, abortive form of epidemic pemphigus of the newborn. It is considered a benign form of staphyloderma. It is manifested by the appearance of single-chamber bubbles located separately from each other in a small amount. The size of the bubbles - from a pea to a cherry, they are covered with a thin, tense...

Vesiculopustulosis is a type of staphyloderma that develops in infants. Vesiculopustulosis is a purulent inflammatory skin disease caused by a variety of pathogens (staphylococci, streptococci, pneumococci, coli, Proteus vulgaris, Pseudomonas aeruginosa, etc.).

These are pyodermatitis, in which etiological factors(causative agents) are both staphylococci and streptococci. This group includes the following diseases: from superficial forms - vulgar, or strepto-staphylococcal impetigo, from deep pyodermatitis - their atypical varieties, such as ...

Rubromycosis (rubrophytosis) - common fungal disease caused by the fungus Trichophyton rubrum (red trichophyton), affecting the soles, palms, smooth skin, vellus hair and nails.

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You need to be very careful about your overall health. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. To do this, you just need to several times a year be examined by a doctor not only to prevent terrible disease but also support healthy mind in the body and the body as a whole.

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Progressive damage to the subcutaneous adipose tissue of an inflammatory nature, leading to the destruction of fat cells and their replacement connective tissue with the formation of nodes, plaques or infiltrates. With the visceral form of panniculitis, the fat cells of the liver, pancreas, kidneys, fatty tissue of the omentum or retroperitoneal region are affected. Diagnosis of the disease is based on the clinic and histological examination data. Treatment for panniculitis depends on its form.

General information

Approximately half of the cases of panniculitis are spontaneous (idiopathic) forms of the disease, which are more common in women aged 20 to 50 years. The remaining 50% are cases of secondary panniculitis, which develops against the background of systemic and skin diseases, immunological disorders, and the action of various provoking factors (cold, certain medications). It is known that the development of panniculitis is based on a violation of lipid peroxidation. But, despite numerous studies in the field of etiology and pathogenesis of this disease, dermatology still does not have a clear idea of ​​the mechanism of its occurrence.

Classification of panniculitis

In the classification of panniculitis, a primary or spontaneous form of the disease (Weber-Christian panniculitis) and a secondary one are distinguished. Secondary panniculitis includes:

• immunological - often observed against the background of systemic vasculitis, in children it may be a variant of the course of erythema nodosum;
• lupus (lupus-panniculitis) - develops with deep form systemic lupus erythematosus, characterized by a combination of symptoms of panniculitis with skin manifestations typical of discoid lupus;
• enzymatic - associated with exposure to pancreatic enzymes, the level of which in the blood increases with pancreatitis;
• proliferative-cellular - occurs with leukemia, lymphoma, histiocytosis, etc.
• cold - a local form of panniculitis that develops in response to strong cold exposure, manifests itself as dense pink nodes that disappear within 2-3 weeks;
• steroid - may occur in children within 1-2 weeks after the end general treatment corticosteroids, is characterized by spontaneous healing and does not require therapy;
• artificial - associated with the introduction of certain medications;
• crystalline - develops with gout and renal failure due to the deposition of urates and calcifications in the subcutaneous tissue, as well as with the deposition of crystals after injections of pentazocine or meneridine;
• panniculitis associated with deficiency of α1-antitrypsin (an α-protease inhibitor), - hereditary disease accompanied by systemic manifestations: vasculitis, hemorrhages, pancreatitis, hepatitis, nephritis.

According to the shape of the nodes formed during panniculitis, nodal, infiltrative and plaque variants of the disease are distinguished.

Symptoms of panniculitis

The main manifestation of spontaneous panniculitis are nodular formations located in the subcutaneous fat on different depth. Most often they appear on the legs and arms, less often - in the abdomen, chest or face. After the resolution of the nodes of panniculitis, foci of atrophy of fatty tissue remain, which look like rounded areas of skin retraction.

The nodular variant of panniculitis is characterized by the appearance in the subcutaneous tissue of typical separately located nodes ranging in size from 3-4 mm to 5 cm. The skin over the nodes can have a color from normal to bright pink.

The plaque variant of panniculitis is a separate accumulation of nodes, which, growing together, form hilly conglomerates. The color of the skin over such formations is pink, burgundy or burgundy-bluish. In some cases, conglomerates of nodes extend to the entire tissue of the lower leg, shoulder or thigh, while squeezing the vascular and nerve bundles, which causes severe pain and swelling of the limb, leads to lymphostasis.

The infiltrative variant of panniculitis proceeds with the melting of nodes or their conglomerates. In this case, in the area of ​​​​the node or plaque, as a rule, a bright red or burgundy hue, a fluctuation appears, typical of an abscess or phlegmon. However, when the nodes are opened, it is not pus that comes out of them, but an oily mass. yellow color. At the site of the opened node, a long-term non-healing ulceration is formed.

A mixed variant of panniculitis is rare and represents a transition from a nodular form to a plaque, and then to an infiltrative one.

Changes in the subcutaneous adipose tissue in the case of spontaneous panniculitis may not be accompanied by a violation general condition patient. But more often at the onset of the disease, symptoms similar to those acute infections(SARS, influenza, measles, rubella, etc.): headache, general weakness, fever, arthralgia, muscle pain, nausea.

The visceral form of panniculitis is characterized by a systemic lesion of fat cells throughout the body with the development of pancreatitis, hepatitis, nephritis, the formation of characteristic nodes in the retroperitoneal tissue and omentum.

In its course, panniculitis can be acute, subacute and recurrent, lasting from 2-3 weeks to several years. acute form panniculitis is characterized pronounced change general condition with high fever, myalgia, joint pain, impaired kidney and liver function. Despite the ongoing treatment, the patient's condition progressively worsens, occasionally there are short remissions, but within a year the disease ends in death.

The subacute course of panniculitis is more smoothed. For him, a violation of the general condition, fever, changes functional tests liver, resistance to treatment. The most favorable recurrent or chronic course of panniculitis. At the same time, relapses of the disease are not severe, often without changing the general state of health and alternate with long-term remissions.

Diagnosis of panniculitis

The diagnosis of panniculitis is carried out by a dermatologist together with a rheumatologist, nephrologist and gastroenterologist. The patient is prescribed biochemical analysis blood and urine tests, liver tests, pancreatic enzymes, Rehberg's test. The identification of nodes of visceral panniculitis is carried out using ultrasound of the organs abdominal cavity, Ultrasound of the kidneys . pancreas and ultrasound of the liver. Blood culture for sterility eliminates the septic nature of the disease. To differentiate the infiltrative variant of panniculitis from an abscess, bacteriological examination separable exposed node.

An accurate diagnosis of panniculitis is established by the results of a node biopsy. At histological examination reveal inflammatory infiltration, necrosis of fat cells and their replacement with connective tissue. The diagnosis of lupus panniculitis is based on data immunological research: determination of antinuclear factor, antibodies to ds-DNA, complement C3 and C4, antibodies to SS-A, etc.

Differential diagnosis of panniculitis is carried out with erythema nodosum, lipoma, oleogranuloma, insulin lipodystrophy in diabetes mellitus,