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.     

Pancreatic panniculitis in active systemic lupus erythematosus

This report documents the case of a 64‐year‐old African‐American female with new end‐stage renal disease (ESRD), diagnosed with systemic lupus erythematosus (SLE) on renal biopsy and serologies including a positive ANA (>1:2560), positive anti‐Sm antibodies, low titer anti‐RNP antibodies, high titer anti‐Ro antibodies, anti‐dsDNA antibodies, lupus anticoagulant, and hypocomplementemia. She was also noted to have tender nodules on the bilateral shins. Excisional biopsy of one of the nodules showed marked fat necrosis with “ghost cells” and patchy basophilic granular debris consistent with pancreatic panniculitis. Further examination for pancreatic pathology showed an elevated lipase of 585 U/L (reference range 8‐78 U/L) and amylase of 214 U/L (reference range 25‐125 U/L). However, computed tomography imaging showed no evidence of pancreatitis or pancreatic tumors. This is very similar to another case recently reported in the literature. Similarities of these two cases (African‐American females with lupus nephritis on dialysis) may represent a particular subset of SLE patients at increased risk for pancreatic panniculitis.     

Panniculitis with crystals induced by etanercept subcutaneous injection

Panniculitis with lipid crystallization within adipocytes may be seen in several disorders, including crystal‐storing histiocytosis, gouty panniculitis, subcutaneous fat necrosis of the newborn, post‐steroid panniculitis, sclerema neonatorum, oxalosis and subcutaneous fungal infections by mucormycosis, zygomycosis or aspergillosis. Panniculitis at the sites of subcutaneous injection of drugs are frequent, but to our knowledge no crystals have been described in the drug‐induced panniculitis at the sites of subcutaneous injections. We report on a patient who developed a panniculitis with lipid crystallization at the site of etanercept injection.     

Cryolipolysis: A Guide for Primary Care Practitioners

A desire for the ideal body image has influenced the development of a nonsurgical body-shaping procedure known as cryolipolysis. The purpose of this clinical feature is to inform nurse practitioners about the risks and benefits of cryolipolysis so they can educate their patients. Cryolipolysis is a safe, effective method of reducing small areas of unwanted fat. Adverse effects are minimal and include pain, redness, bruising, and swelling. Results are seen within 12 weeks, but long-term effects are unknown. There are contraindications, and it is relatively expensive; however, it may be a safer option than invasive surgery.     

Equestrian chilblain: another outdoor recreational hazard

Herein, we describe two cases and review 14 cases of equestrian chilblain or ‘equestrian cold panniculitis’ in the literature. The first, a 23‐year‐old healthy female horse trainer, presented with burning nodular swelling on her lateral thighs. The second was a 34‐year‐old healthy woman with recurrent nodular eruption on the lateral thighs after horseback riding in the winter. Physical examination of both patients revealed erythematous to violaceous nodules with eczema craquelé‐like changes. Laboratory workup for systemic and autoimmune connective tissue disease was negative. Punch biopsies from both patients showed a superficial and deep perivascular and periadnexal lymphocytic infiltrate with focal extension into the subcutaneous fat. Parakeratosis, subtle spongiosis and increased pandermal interstitial mucin were also present. Previously reported cases generally showed a similar clinical course and similar histopathologic findings. In contrast, our cases revealed increased pandermal interstitial mucin, resembling tumid lupus erythematosus. We aim to better characterize the histopathologic findings of equestrian chilblain and discuss its relationship to other cold‐induced skin injuries and autoimmune connective tissue disease, namely lupus erythematosus.