Lipoatrophic panniculitis in an adolescent

Lipoatrophic panniculitis (LP) is a rare childhood panniculitis characterized by sclerotic, atrophic plaques on the extremities. We present a case of LP diagnosed during the inflammatory phase that was difficult to distinguish clinically from eosinophilic fasciitis. This report adds to the limited phenotypic spectrum of LP by differentiating the clinical features of disease activity from disease damage and highlighting the importance of biopsy in establishing a diagnosis.     

Subcutaneous granuloma annulare involving the scalp

Subcutaneous granuloma annulare (SGA) is an uncommon subtype of granuloma annulare. There are few reports of this entity solely affecting the scalp. We report a case of biopsy‐proven SGA in a 21‐month‐old boy with six asymptomatic, rock‐hard scalp nodules.     

A novel selective RF applicator for reducing thigh circumference: a clinical evaluation

The demand for noninvasive body contouring procedures continues to drive the development of new technology to treat areas on the body that are more resistant to diet and exercise. This study assesses the safety and efficacy of a novel selective RF applicator as a noninvasive, contactless method for reducing thigh circumference using a radiofrequency electric field (Vanquish Flex Applicator, BTL Industries Inc., Boston, MA). Forty‐two female subjects were enrolled to undergo a treatment of their bilateral inner and outer thighs (saddle bags) once weekly for 4 weeks. Thigh circumference was measured at the baseline and 2 weeks after the fourth treatment. The primary objective was the evaluation of clinical outcomes of 40 treated subjects. Safety of the device was assessed based on adverse events reports during the course of the study. Forty subjects completed the study. After four treatments, the therapy group showed a statistically significant (p < 0.001) reduction in thigh circumference of 2.43 cm compared with an untreated control group of 10 patients, where no change was seen (p = 0.297). No treatment associated pain or discomfort was reported by the subjects. There were also no reports of adverse events. This study demonstrates that the contactless RF Applicator is safe, painless and effective for the circumferential reduction of the thighs.     

Neutrophilic panniculitis developing after treatment of metastatic melanoma with vemurafenib

Vemurafenib is an inhibitor of BRAF and is used to treat patients with metastatic melanoma who carry a V600E BRAF mutation. Recently, four patients have been described in the literature who developed a neutrophilic panniculitis following treatment with a BRAF inhibitor. We present an additional case and review the clinical findings of the cases reported to date.     

Pancreatic fat necrosis in a 10‐year‐old girl: A case report and review of the literature

We report here a case of a young girl with pancreatitis and pancreatic fat necrosis (PFN). This condition is rare in the pediatric age group, and its etiopathogenesis is different from disease in adults. Whereas PFN in adults typically results from pancreatitis secondary to pancreatic duct obstruction, alcohol abuse, and pancreatic adenocarcinoma, in children it appears to arise in a setting of systemic disease, often involving a genetic disorder.     

Expression of cutaneous immunity markers during infant skin maturation

Background/Objectives

Infant skin undergoes a maturation process during the early years of life. Little is known about the skin's innate immunity. We investigated the dynamics of innate immunity markers collected from the surface of infant skin during the first 36 months of life.

Methods

A total of 117 healthy infants aged 3‐36 months participated in the study. We extracted human beta defensin‐1 and interleukin 1 alpha and its receptor antagonist using transdermal analysis patches from the skin surface of the posterior lower leg area. The extracts were analyzed using a spot enzyme‐linked immunosorbent assay.

Results

Skin surface human beta defensin‐1 levels were higher early in life and decreased with infant age. The ratio of interleukin 1 alpha receptor antagonist to interleukin 1 alpha did not change significantly with age but showed a distinct difference between sexes, with female infants having higher values than male infants.

Conclusion

As is the case with skin structure and functional properties, cutaneous innate immunity also appears to undergo a maturation period during infancy, with innate immunity slowly declining as adaptive immunity takes over. Sex differences in immune markers may explain sex‐dependent susceptibilities to infection.     

硬化性脂膜炎

报告1例硬化性脂膜炎．患者男,54岁．右小腿外侧一暗红色结节,质硬伴疼痛3个门,皮损组织病理检查可见皮下脂肪小叶中心缺缸性坏死,膜性脂肪坏死,部分坏死脂肪形成囊肿,小叶间隔纤维化明显。     

Community-associated methicillin-resistant Staphylococcus aureus skin infections in the tropics

Skin and soft tissue infections (SSTI) caused by Staphylococcus aureus are very common, particularly in children, in tropical regions. The proportion of S aureus SSTI caused by community-associated methicillin-resistant S aureus (CA-MRSA) varies according to region, but is up to 25% in some areas. There are diverse CA-MRSA clones, including several that harbor Panton-Valentine leukocidin. Key predisposing factors for staphylococcal infections are scabies infestation, overcrowding, poor hygiene, and inadequate water supplies. In the setting of a community outbreak of staphylococcal SSTI, interventions intended to improve personal and community hygiene are likely to be the most practical, effective, and achievable. Options for oral treatment of clinical infections caused by CA-MRSA include clindamycin and trimethoprim-sulfamethoxazole. Although rapid diagnostics are now available, and 2 vaccines have reached clinical trials, neither of these is likely to be of use in tropical, developing regions in the near future.     

Factitial panniculitis

Factitial panniculitides are subcutaneous tissue injuries produced by external agents or actions. In most cases, factitial panniculitis is caused by self-injection of different substances. Factitial panniculitis can also appear as an iatrogenic consequence of injections of drugs or immunization agents. The clinical features of factitial panniculitis are quite variable, depending on the inciting agent. The histopathology of factitial panniculitis usually shows a pattern of an acute lobular panniculitis associated with fat necrosis and an abundant inflammatory infiltrate predominantly composed of neutrophils.     

Protecting patients from harm: reducing methicillin-resistant Staphylococcus aureus infections

PURPOSE: To provide wound care practitioners with information about interventions to prevent, reduce, or treat methicillin-resistant Staphylococcus aureus (MRSA) infections. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Discuss the transmission of MRSA infections. 2. Identify ways to prevent MRSA infections. 3. Identify ways to treat MRSA infections.     

Cutaneous community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus

The clinical presentation of methicillin-resistant Staphylococcus aureus (MRSA) infection ranges from asymptomatic colonization to cutaneous and invasive involvement. This review discusses the cutaneous presentations of community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA) that one may encounter in the hospital or outpatient setting. Cutaneous CA-MRSA and HA-MRSA are often clinically indistinguishable, although they have different epidemiologic profiles and virulence factors. Bacterial culture is necessary for diagnosis and guides treatment, as infection with CA-MRSA and HA-MRSA require distinct clinical management. Guidelines for surgical interventions and antibiotic treatment of CA-MRSA and HA-MRSA will be discussed. Strategies for MRSA decolonization and prevention of further spread will also be reviewed.     

Acquired idiopathic lipoatrophic panniculitis in a 12‐month‐old infant

Lipoatrophic panniculitis is a rare condition affecting mainly children, often associated with connective tissue disease. We report a healthy 12‐month‐old girl with no clinical or laboratory features of connective tissue disease who presented with the progressive appearance of annular atrophic plaques beginning at the left arm. A histopathological analysis revealed lobular panniculitis, with fat necrosis and an associated inflammatory infiltrate supporting the diagnosis of lipoatrophic panniculitis. Lipoatrophic panniculitis should be considered in infants and young children with clinical features of panniculitis and fat atrophy even without clinical or serologic evidence of connective tissue disease.     

Panniculitis in juvenile dermatomyositis: Report of a case and review of the published work

We report a 15‐year‐old girl who presented with indurated, subcutaneous nodules in addition to classical findings of juvenile dermatomyositis. Histopathological examination confirmed the diagnosis of panniculitis associated with juvenile dermatomyositis. Considering that panniculitis is a rare cutaneous manifestation of juvenile dermatomyositis, we present a patient with a brief review of the published work to highlight the importance of keeping juvenile dermatomyositis in mind among the etiologies of pediatric panniculitis.     

Early pancreatic panniculitis associated with HELLP syndrome and acute fatty liver of pregnancy

Pancreatic panniculitis represents a rare cutaneous disorder most commonly associated with acute or chronic pancreatitis or pancreatic carcinoma. We describe a case of a 17-year-old woman who presented with a 2-day history of erythematous patches involving her bilateral knees and tender, scattered red-brown nodules involving her bilateral anterior shins. She was seen during a hospitalization for emergent cesarean section and her hospital course was complicated by HELLP syndrome (defined by the presence of hemolysis, elevated liver enzymes, low platelet count), acute fatty liver of pregnancy and pancreatitis. The characteristic histopathologic findings, including ghost cells, fat necrosis and granular basophilic material with dystrophic calcification, appear in later lesions. In early lesions, as was shown in this case, a neutrophilic subcutaneous infiltrate raises a differential diagnosis including infection, subcutaneous Sweet's syndrome or atypical erythema nodosum. To our knowledge, this represents the first report of pancreatic panniculitis in association with HELLP syndrome and acute fatty liver of pregnancy. Early recognition is critical, as skin lesions may precede the development of pancreatitis. Often, as in our case, the effects of pancreatitis may be life threatening.     

Q fever: a new cause of 'doughnut' granulomatous lobular panniculitis

Q fever is an uncommon zoonotic rickettsial disease with no exanthem or specific cutaneous lesions. Only nonspecific cutaneous involvement has been reported to date. A 69-year-old Spanish woman with chronic myelogenous leukaemia developed fever and two subcutaneous nodules. The patient complained of extreme pain. Biopsy revealed a granulomatous lobular panniculitis with a characteristic 'fibrin ring' or 'doughnut' appearance: fibrin and inflammatory cells arranged around a central clear space. Changes of membranous lipodystrophy were also found. Q fever serological studies were positive. Our patient had panniculitis with singular histopathological features. These histopathological changes have been described in liver and bone marrow of patients with Q fever. To the best of our knowledge, this cutaneous involvement due to Q fever has not previously been described in the literature.     

Cytophagic histiocytic panniculitis and hemophagocytic lymphohistiocytosis: an overview

Cytophagic histiocytic panniculitis (CHP) is a rare panniculitis that is associated with systemic features including fevers, hepatosplenomegaly, lymphadenopathy, pancytopenia, hepatic abnormalities, hypertriglyceridemia, and coagulopathy without an elevated erythrocyte sedimentation rate. The panniculitis lesions show adipose tissue lymphocytic and histiocytic infiltration along with hemophagocytosis, which may also appear in bone marrow, spleen, lymph nodes, and liver. Patients may have a rapidly fatal disease course, a longer disease course with intermittent remissions and exacerbations for many years prior to death, or a nonfatal acute or intermittent course responsive to treatment. The cytophagocytic disorder in these patients is a hemophagocytic lymphohistiocytosis (HLH), similar to the infection‐activated reaction associated with perforin mutations found in familial hemophagocytic lymphohistiocytosis. HLH is a group of autoinflammatory disorders, which include macrophage activation syndrome and infection‐associated hemophagocytic syndrome, which if not treated rapidly, can be fatal. The relationship of CHP and HLH is discussed. CHP associated diseases include: subcutaneous panniculitis‐like T cell lymphomas; infections, connective tissue diseases, other malignancies, and the molecular disorders that cause HLH. Treatment of CHP includes: glucocorticoids in combination with cyclosporine, combined chemotherapeutic medications and most recently, anakinra, an Interleukin‐1 receptor antagonist; along with supportive care, search for underlying malignancies and treatment thereof, and control of associated infections.     

Facets of lupus erythematosus: panniculitis responding to thalidomide

Lupus erythematosus profundus or lupus panniculitis is a rare clinical variant of lupus erythematosus, which involves the deep dermis and subcutaneous fat. Diagnosis may be difficult in cases with isolated involvement. Further manifestations of lupus erythematosus may thus be essential for diagnosis, which depends on the clinical picture, histopathology and a positive lesional lupus band test. We report a severe, mutilating case of lupus panniculitis, which responded well to thalidomide.     

Lupus panniculitis with combined features of dermatomyositis resulting in severe lipoatrophy

An 11-year-old girl presented with a one-year history of multiple, hard, slightly painful subcutaneous nodules on her right cheek, upper arms, and buttock. Histology of a skin biopsy specimen showed a lobular panniculitis. Laboratory studies revealed positive ANA, anti-double strand DNA, and elevated muscle enzymes. She was diagnosed as having lupus panniculitis. During hydroxychloroquine treatment, erythema over knuckle joints developed. These unusual clinical and laboratory findings of panniculitis associated connective tissue diseases made it difficult to make a precise diagnosis. We report this unusual case of lupus panniculitis with combined features of dermatomyositis resulting in severe lipoatrophy.