Disease

Panniculitis - a rare disease of subcutaneous fat

Pin
+1
Send
Share
Send

Panniculitis - a progressive lesion of the subcutaneous fatty tissue of an inflammatory nature, leading to the destruction of fat cells and their replacement with connective tissue with the formation of nodes, plaques or infiltrates. With the visceral form of panniculitis, damage to the fat cells of the liver, pancreas, kidneys, adipose tissue or retroperitoneal region occurs. Diagnosis of the disease is based on the clinic and histological examination data. The treatment of panniculitis depends on its form.

General information

About half of the cases of panniculitis occur in a spontaneous (idiopathic) form of the disease, which is more common in women aged 20 to 50 years. The remaining 50% are cases of secondary panniculitis, developing against a background of systemic and skin diseases, immunological disorders, the effects of various provoking factors (cold, some medications). It is known that the development of panniculitis is a violation of the peroxidation of fats. But, despite numerous studies in the 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, the primary or spontaneous form of the disease (Weber-Christian panniculitis) and the secondary are distinguished. Secondary panniculitis include:

  • immunological - it is often observed against the background of systemic vasculitis, in children it may be a variant of the course of erythema nodosum,
  • lupus erythematosus (lupus-panniculitis) - develops with a deep form of systemic lupus erythematosus, is 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 rises with pancreatitis,
  • proliferative cell - occurs with leukemia, lymphoma, histiocytosis, etc.
  • cold - a local form of panniculitis that develops in response to a strong cold effect, manifests itself in dense pink nodes that pass within 2-3 weeks,
  • steroid - can occur in children within 1-2 weeks after the end of general treatment with corticosteroids, is characterized by spontaneous treatment 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 urate and calcifications in the subcutaneous tissue, as well as the deposition of crystals after injections of pentazocine or meneridine,
  • panniculitis associated with a deficiency of α1-antitrypsin (an α-protease inhibitor) is a hereditary disease accompanied by systemic manifestations: vasculitis, hemorrhages, pancreatitis, hepatitis, nephritis.

In the form of nodes formed during panniculitis, nodular, infiltrative and plaque variants of the disease are distinguished.

Symptoms of Panniculitis

The main manifestation of spontaneous panniculitis are nodules located in the subcutaneous fat at various depths. Most often, they appear on the legs and arms, less often in the abdomen, chest or face. After resolving the nodes of the panniculitis, there remain foci of atrophy of adipose tissue, which look like rounded areas of skin retraction.

The nodal 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 above the nodes can have a color from ordinary to bright pink.

The plaque variant of panniculitis is a separate cluster of nodes, which, growing together, form tuberous conglomerates. The color of the skin over such formations is pink, burgundy or burgundy-cyanotic. 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 leads to severe pain and swelling of the limb, leading to lymphostasis.

The infiltrative variant of panniculitis proceeds with the fusion of nodes or their conglomerates. Moreover, in the area of ​​the node or plaque, as a rule, a bright red or burgundy shade, a fluctuation appears, typical of an abscess or phlegmon. However, when the nodes are opened, not pus comes out of them, but an oily mass of yellow color. At the site of the opening node, a long-term non-healing ulceration forms.

A mixed variant of panniculitis is rare and represents a transition of the nodular form into plaque, and then into infiltrative.

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

The visceral form of panniculitis is characterized by systemic damage to 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. The acute form of panniculitis is characterized by a pronounced change in the general condition with high fever, myalgia, joint pain, impaired renal and hepatic function. Despite the treatment, the patient's condition progressively worsens, occasionally there are short remissions, but during the year the disease ends in death.

Subacute course of panniculitis is more smooth. A typical violation of the general condition, fever, changes in liver function tests, and resistance to treatment are typical. The most favorable recurrent or chronic course of panniculitis. In this case, relapses of the disease are not difficult, often without changing the general state of health, and alternate with long-term remissions.

Diagnosis of panniculitis

A dermatologist conducts the diagnosis of panniculitis together with a rheumatologist, nephrologist and gastroenterologist. The patient is prescribed a biochemical analysis of blood and urine, liver tests, a study of pancreatic enzymes, a Reberg test. Identification of nodes of visceral panniculitis is carried out using ultrasound of the abdominal organs, 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 the abscess, a bacteriological study of the detached opening node is performed.

An accurate diagnosis of panniculitis is established by a node biopsy. Histological examination reveals inflammatory infiltration, necrosis of fat cells and their replacement with connective tissue. Diagnosis of lupus panniculitis is based on data from immunological studies: 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, actinomycosis, and inductive tuberculosis.

Panniculitis treatment

Therapy of panniculitis is carried out comprehensively, depending on its form and course. For the treatment of chronic nodular panniculitis, non-steroidal anti-inflammatory drugs (naproxen, diclofenac) and antioxidants (vitamin E, ascorbic acid) are prescribed, and single nodules are chipped with glucocorticoids. Physiotherapy procedures are effective: UHF, phonophoresis of hydrocortisone, magnetotherapy, ozokerite, ultrasound, laser therapy.

With a plaque and infiltrative form, subacute course of panniculitis, glucocorticosteroids (hydrocortisone, prednisone) and cytostatics (cyclophosphamide, methotrexate) are used. To improve liver function, the appointment of hepatoprotectors is advisable. Treatment of secondary forms of panniculitis necessarily includes the treatment of background disease: pancreatitis, SLE, vasculitis, gout.

What causes panniculitis

Most often lead to panniculitis:

  • autoimmune diseases of connective tissues (lupus erythematosus, vasculitis - periarteritis nodosa, B. Horton, etc.),
  • systemic arthritis,
  • fat metabolism disorders,
  • extreme stage of obesity,
  • organ diseases (pancreatitis, gout, renal failure, hepatitis, diabetes, nephritis),
  • infectious and viral diseases (staphylococcal and streptococcal infections, fungal infections, syphilis),
  • malignant processes (leukemia, soft tissue tumors),
  • lymphadenitis
  • traumatic skin lesions,
  • the formation of post-burn and postoperative scars,
  • plastic surgery (in particular, unsuccessful liposuction),
  • the use of certain treatment regimens and medications:
    • e.g. cold treatment
    • the use of pentazocine or meperidine,
    • long-term therapy with corticosteroids (panniculitis here may occur in the form of withdrawal syndrome),
  • hereditary and congenital diseases (congenital lupus erythematosus, pulmonary insufficiency, lack of alpha-antitrypsin, etc.),
  • low immunity due to AIDS, chemotherapy and other reasons,
  • intravenous drug use.

Classification by flow pattern

Panniculitis has different forms of flow: acute, subacute, and relapse.

  • In the acute form of panniculitis, there are vivid clinical manifestations: fever, myalgia and arthralgia, visceral symptoms with signs of renal and hepatic pathologies.
  • Subacute panniculitis has milder symptoms. It is accompanied by the onset of destructive processes in the subcutaneous layer.
  • Relapse P. occurs in a chronic form into which untreated disease passes. It manifests itself in periodic outbreaks of the disease, after which there is a remission (a period of normal health).

Clinical classification

Clinically distinguish four forms:

  • nodal (in the form of single nodes of small and large nodes of pink, red, purple),
  • plaque (multiple tuberous nodes of cyanotic or crimson hue form plaques located on the trunk and limbs),
  • inflammatory-infiltrative (abscesses occur in the subcutaneous layer, which penetrate into the deeper layers and organs),
  • visceral, in which fatty tissues of the liver, pancreas, kidneys, intestines and other organs can be affected.

Panniculitis can have a mixed form of flow, in which the nodular form flows into the plaque and then into the inflammatory-infiltrative.

Classifications for reasons

Some characteristic types of panniculitis have their own specific names for the reasons that caused them:

  • So, panniculitis caused by treatment, surgery, medications or drugs is called artificial P.
  • Autoimmune connective tissue pathologies - immunological.
  • Lupus erythematosus - lupus erythematosus.
  • Gout, renal failure, taking drugs that exceed crystallization - crystalline.
  • Pancreatitis - enzymatic P.
  • Inherited diseases - hereditary panniculitis.

Mesenteric Panniculitis

A separate rare variety of visceral P. is mesenteric panniculitis, leading to scarring of the mesentery - a double thin membrane that covers all the loops of the intestine, attaches them to the back wall of the abdominal cavity, preventing twisting.

Panniculitis is usually a consequence of the inflammatory process in the digestive tract, can lead to vascular thrombosis and necrosis of the tissues of the small intestine. This pathology is observed infrequently, what is its cause is not known for certain.

Lupus erythematosus

It combines the typical symptoms of panniculitis with specific dermatosis with discoid lupus erythematosus: nodes, plaques and infiltrates develop against a pink-red scaly erythematous rash.

Lupus panniculitis is characterized by a severe course with damage to connective tissues, joints and organs.

Stages of Panniculitis

  • In the first stage of P. (inflammatory), fluid infiltrate accumulates in the tissues of the skin and fat, which is manifested by swelling and symptoms of exacerbation.
  • In the second subacute stage, histology reveals necrotic areas in the subcutaneous fat layer, histiocytic phagocytosis.
  • The third stage of P. manifests itself in the formation of: scars and adhesions, cavities filled with fluid and collagen, calcium subcutaneous deposits.

Acute and subacute panniculitis

Acute panniculitis recalls the symptoms of ARVI, an attack of rheumatoid or infectious arthritis:

  • the patient’s temperature suddenly rises to high values,
  • headache, muscle pain and joint pain are observed,
  • nausea, vomiting, sleep disturbances are possible.

To differentiate P. from other diseases it is possible according to skin signs:

  • nodes from 5 to 35 mm in size appear on the skin, filled with fluid and pus,
  • in place of the opened and healed node, retracting scars and spots of burgundy, reddish, bluish color are formed,
  • gradually, the nodes become more and more, and they form into lumpy plaques,
  • the spots do not go away for a very long time,
  • over time at chronic P. the plaques pass into infiltrates.

When the swelling of the nodes decreases, the symptoms of exacerbation disappear. Instrumental diagnostics allows you to determine the change in the structure of the subcutaneous layer: skin atrophy and fibrosis of adipose tissue. These are symptoms characteristic of the subacute stage.

Chronic recurrent panniculitis

In remission, there are no symptoms of general well-being. A new outbreak of P. manifests with the same clinical signs as acute panniculitis. But exacerbation in chronic panniculitis is more difficult, since at this stage visceral symptoms are already possible, associated with damage to the tissues of the liver, heart, spleen, lungs and other organs. Observed:

  • hepatomegaly and splenomegaly,
  • heart rhythm disturbances
  • respiratory failure
  • hemogram changes (decrease in white blood cells, eosinophilia, moderate increase in ESR).

The resulting nodes compress the nerve, blood and lymph vessels, leading to pain, circulatory disorders and lymphostasis - edema in the pathological areas due to poor lymph circulation.

The infiltrative and proliferative form of P., often observed in oncological pathologies, is characterized by rapid growth of nodes, their decay, organ damage, and patient weakness.

Chronic recurrent panniculitis has an unfavorable prognosis, since sooner or later it leads to sepsis, gangrene of the extremities, cirrhosis of the liver and other lesions of vital organs.

Symptoms of Cervical Panniculitis

Cervical panniculitis is at least a rare, but very dangerous disease, as it can in a neglected form lead to compression of the vertebral artery, the development of ischemia and irreversible brain changes.

Cervical panniculitis can be suspected with the following symptoms:

  • acute pain and swelling in the neck against a background of high temperature,
  • restriction of mobility of the cervical spine,
  • tuberous skin surface, spots, skin retraction in the cervical region,
  • headaches, dizziness,
  • darkness in the eyes, floating objects in the visual field,
  • hearing impairment
  • disorders of memory, mental ability and other phenomena of dementia.

Another complication of cervical panniculitis is infiltrative inflammation of the membranes of the spinal cord, the development of an ascending infection and meningitis. In this case, P. develops rapidly and quickly leads to death.

Laboratory and instrumental examination

  • laboratory analysis (general blood hemogram, bacteriological analysis, liver, pancreatic tests, urine tests, immunological tests),
  • Ultrasound of organs, x-ray, CT or MRI,
  • subcutaneous tissue biopsy followed by histology.

With lupus panniculitis, tests are taken:

  • antinuclear factor
  • complement level (on the activity of serum proteins),
  • for antibodies (specific immunoglobulins).

Conservative and surgical treatment

Treatment of panniculitis should be comprehensive:

  • anti-infective, anti-inflammatory and anti-edematous therapy (antibiotics of the penicillin group or SDS, NSAIDs, antiviral drugs, glucocorticosteroids, cyclophosphamide),
  • surgical removal of nodes that cause vascular compression,
  • opening and removal of abscesses, abscesses, phlegmon with washing cavities with disinfectant solutions,
  • detoxification (intake of sorbents, plasma transfusion),
  • antisuppressants, if the cause of panniculitis is an autoimmune disease,
  • hepatoprotectors
  • hemodialysis,
  • physiotherapy (UV, UHF, UVT, laser therapy),
  • vitamin therapy and other methods.

Patient behavior with panniculitis

A patient with panniculitis needs:

  • drink a lot,
  • observe bed rest during exacerbations,
  • adhere to a diet that restricts fatty, salty, protein, fried foods,
  • eat a lot of vegetables and fruits,
  • give up alcohol and smoking,
  • keep track of your weight
  • constantly observed by a doctor.

The fulfillment of all these conditions with panniculitis will improve the prognosis and lead to recovery.

Etiology

Almost half the cases of the occurrence of such a disease are idiopathic in nature - this means that damage to the subcutaneous tissue develops spontaneously, without any pathological prerequisites. In this case, the main risk group is represented by women in the age category from 20 to 50 years.

The second half was called secondary panniculitis, because it develops against the background:

  • eczema, herpes zoster, or other pathologies that adversely affect the skin,
  • penetration of pathogenic bacteria, viruses, parasites or protozoa, as well as helminthic invasion,
  • the presence of chronic edema of the upper and lower extremities in a person - the swollen skin is prone to cracking, which affects the vulnerability of nearby tissues to infectious processes,
  • previous similar pathology - this means that the disease is prone to relapse,
  • any factors leading to a violation of the integrity of the skin,
  • acute course or untimely treatment of gastroenterological ailments. This leads to the fact that nodular neoplasms can form on the fatty tissue of the liver and pancreas. Less affected kidneys and omentum.

Among the predisposing factors that significantly increase the risk of such a disease, it is worth highlighting:

  • any conditions that lead to a decrease in the resistance of the immune system,
  • the course of diabetes or leukemia,
  • the presence of HIV infection or AIDS,
  • addiction to bad habits, in particular to the intravenous administration of narcotic substances,
  • uncontrolled medication, such as corticosteroids,
  • prolonged hypothermia of the body,
  • the presence of excess body weight.

Despite the fact that dermatological clinicians know the causes and predisposing factors, the mechanism of the occurrence of such a disease remains not fully understood. The theory that the basis of inflammation of fatty tissue is the incorrect process of fat oxidation is considered the most common.

Symptomatology

The main clinical sign of panniculitis is nodular neoplasms, which can be localized at different depths of subcutaneous fat. Most often they appear:

  • in the upper and lower extremities,
  • in the abdominal cavity
  • in the sternum
  • on the face.

The most rare lesions include the intestines and cervical spine. After the nodes are resorbed, foci of atrophy may appear in the fatty tissue, outwardly having the appearance of rounded zones of skin retraction.

The nodal form of the pathology is presented:

  • the emergence of nodes, which in volume can vary from 3 millimeters to 5 centimeters,
  • focal arrangement of nodes,
  • redness of the skin located above the formations.

Plaque variant of the disease is accompanied by such signs:

  • splicing of individual nodes into large conglomerates,
  • the skin may acquire a pink, burgundy or burgundy-cyanotic shade,
  • the spread of conglomerates over the entire area of ​​such fiber areas as the shin or shoulder, thigh or cervical spine,
  • pronounced soreness and swelling of the affected segment.

The infiltrative form of the disease has the following symptoms:

  • fusion of nodes
  • red or burgundy leather
  • the appearance of ulcerations in the area of ​​the opened nodular formation.

The mixed nature of the course of panniculitis develops quite rarely and is expressed in the transition of the nodular form into plaque, and after that into infiltrative.

A spontaneous kind of ailment may have the following symptoms:

  • headache,
  • a slight increase in temperature,
  • sore muscles and joints
  • general weakness and malaise,
  • nausea and vomiting - signs appear when the abdominal cavity is affected.

Mesenteric panniculitis is expressed in:

  • soreness in the epigastric region,
  • subfebrile temperature,
  • impaired bowel function,
  • weight loss
  • well palpable formation in the peritoneum.

At the same time, it is worth noting that this variant of the disease can be completely asymptomatic.

Secondary panniculitis may be supplemented by symptoms of a underlying ailment.

Prevention

To avoid the development of panniculitis, there are no special preventive measures, people only need:

  • to refuse from bad habits,
  • Healthy food,
  • take medicine strictly on the recommendation of the attending physician,
  • avoid hypothermia,
  • keep normal body weight,
  • to strengthen immunity,
  • in the early stages of development to treat ailments that can lead to the formation of panniculitis.

In addition, do not forget about regular preventive examinations in a medical institution. The prognosis depends on the nature of the course of the disease, localization and the number of nodes. Nevertheless, a favorable outcome is often observed.

What is panniculitis?

Panniculitis is an inflammatory disease that affects subcutaneous fat. As a result of pathological processes, fat cells are destroyed and their connective tissue is replaced. As a rule, the disease is accompanied by the formation of plaques and nodes.

There are three main forms of panniculitis:

  • Visceral - in this case, fatty cells of the kidneys, liver, pancreas or omentum are affected.
  • Idiopathic form (found quite often - 50% of all cases of detection of the disease).
  • Secondary panniculitis - develops against the background of other diseases, disruption of the immune system, the use of certain medications and other factors.

Secondary panniculitis, in turn, is divided into several types:

  • Immunological - occurs against a background of systemic diseases (vasculitis).
  • Enzymatic - inherent in patients with pancreatitis.
  • Lupus erythematosus - develops on the background of systemic lupus erythematosus.
  • Cold - a local disease that occurs under the influence of low temperatures.
  • Artificial - develops as a result of taking certain medications.
  • Steroid panniculitis occurs after the end of the course of treatment with corticosteroid drugs.

Causes of the disease

The reasons for the development of panniculitis can be varied, it is often encountered:

  • Bacterial damage. Most often this occurs as a result of the development of staphylococcus or streptococcus in the body.
  • Injury or other mechanical damage to tissues and organs.
  • The development of fungal disease.
  • Dermatological diseases: ulcers, dermatitis, etc.
  • Surgery, as a result of which a disease develops at the site of the scar.

In addition, scientists called the premise characteristic for all types of panniculitis - metabolic disturbances and a large accumulation of toxins and decay products in the body, in particular in internal organs and subcutaneous fat.

Diagnosis of the disease

To diagnose the disease, a consultation with a dermatologist is necessary. In some cases, depending on the location of the disease, the help of a gastroenterologist, nephrologist, rheumatologist and other specialists is required.


For an accurate diagnosis, the following diagnostic procedures are used:

  • A thorough examination of the patient, determining the form and type of the disease.
  • Conducting laboratory tests - analysis of urine, blood, liver tests and other studies.
  • Blood culture, which allows to detect the presence of a bacterial infection.
  • Ultrasound examination makes it possible to detect the presence of nodular formations, to establish their localization and size.
  • Biopsy and histology of the obtained biological material. This eliminates the likelihood of developing a malignant neoplasm.

Short description

Approved by the Joint Commission for the Quality of Medical Services
Ministry of Health of the Republic of Kazakhstan
dated November 28, 2017
Protocol No. 33

Panniculitis (fat granuloma) - This is a group of heterogeneous inflammatory diseases characterized by damage to the subcutaneous fat, and often occurring involving the musculoskeletal system and internal organs.

Erythema nodosum -septal panniculitis, which occurs predominantly without vasculitis, due to a non-specific immuno-inflammatory process that develops under the influence of various factors (infections, medications, rheumatological and other diseases).

Idiopathic Panniculitis Weber – Christian (IPVC) is a rare and poorly understood disease that is characterized by recurrent necrotic changes in subcutaneous fatty tissue (PUFA), as well as damage to internal organs.

ICD-10 Code (s):

ICD-10
The code Title
M35.6 Recurrent panniculitis Weber-Christian
L52 Erythema nodosum

Protocol development / revision date:2017 year.

Abbreviations Used in the Protocol:

Monpanniculitis
PVCpanniculitis Weber-Christian
IPVKidiopathic panniculitis Weber-Christian
Pancreassubcutaneous fat
SPNseptal panniculitis
LPnlobular panniculitis
UEerythema nodosum
VUEsecondary erythema nodosum
Agarterial hypertension
ATantibodies
ANCAautoantibodies to neutrophil cytoplasm
GKglucocorticosteroids
CTCT scan
KFKcreatinine phosphokinase
INRinternational normalized attitude
NSAIDsnon-steroidal anti-inflammatory drugs
NEsystemic vasculitis
SRB-C-reactive protein
ESRsedimentation rate of erythrocytes
CNScentral nervous system
Ultrasoundultrasound dopplerography
Ultrasound scanultrasound procedure
FGDSfibrogastroduodenoscopy
ECGelectrocardiogram
ECHOKGechocardiography
MRIMagnetic resonance imaging
INNinternational nonproprietary name

Protocol Users: general practitioners, therapists, rheumatologists, dermatologists.

Patient Category: adults.

Level of evidence:

A A high-quality meta-analysis, a systematic review of RCTs or a large RCT with a very low probability (++) of systematic error results that can be spread to the corresponding population.
IN High-quality (++) systematic cohort or case-control studies or High-quality (++) cohort or case-control studies with a very low risk of systematic error or RCTs with a low (+) risk of systematic error, the results of which can be disseminated to the corresponding population .
FROM A cohort or case-control study or a controlled study without randomization with a low risk of bias (+).
Results that can be distributed to the corresponding population or RCTs with a very low or low risk of bias (++ or +), the results of which cannot be directly distributed to the corresponding population.
D A description of a series of cases or an uncontrolled study or expert opinion.
GPP Best clinical practice.

What is dangerous for you panniculitis?

Panniculitis is a time bomb in your body. The disease is very difficult to treat with conventional medication. With panniculitis, subcutaneous tissue becomes inflamed. Nodules form under the skin, the tissues around them swell, the skin turns red, ulcers form. Pronounced pain syndrome. Atrophy of the tissue occurs, as a result of which scars and grooves form on the site of inflammation on the skin. The inflammatory process is accompanied by fever and fever. The disease affects many internal organs and can have serious consequences for you. Complicates the course of the disease and the aesthetic factor - panniculitis leaves ugly marks on the skin.

What will happen if not treated?

In most cases, the development of panniculitis leads to serious complications that pose a real threat to your health, and often your life. Among these complications:

    Cardiac arrhythmiasHypotensionConfusionDamage to the lymphatic vesselsAbscessSepsis

According to medical research, the rate of development of these pathologies and complications in recent years is growing rapidly.

If you do not take urgent measures or use ineffective treatment, then powerful pathological processes will inevitably start in your body, which will lead to the spread of infection to other organs. In the absence of proper treatment, scars and scars may remain on your skin.

What usually causes panniculitis?

Absolutely all processes in our body are regulated by the brain. Brain cells receive information from all organs and systems, process it, produce the necessary response, and send appropriate orders to the various organs of the body via nerve fibers. Panniculitis (like any other disease) is formed due to a complex of different factors.

These factors lead to a malfunction in some parts of the brain and disruption of neural connections. In other words, the brain stops giving the “right” orders for the precise functioning of your musculoskeletal system, which leads to panniculitis, and then to more serious diseases.

How to cure panniculitis as quickly as possible?

We offer an innovative method of color pulse therapy, the discovery of which is awarded the Nobel Prize.

The answer is obvious: it is necessary to establish a clear work of the brain centers responsible for the regulation of the musculoskeletal system. The Neurodoktor apparatus solves precisely this problem.

The drug was developed based on the method of pulse therapy.This is one of the most progressive and highly effective treatment methods known to modern world medicine. Thanks to pulse therapy, certain sections of the musculoskeletal system “wake up”, which ensures the elimination of failures in its operation. This is due to exposure to the control centers of the brain.

How it works?

The neurodoc affects the control centers of the brain.

The brain begins to produce dozens of neurohormones and form "corrective" nerve impulses.

Neurohormones are many times more effective than the most powerful drugs quickly cure the disease. Nerve impulses eliminate pathological processes at the cellular level and adjust the functioning of other organs and systems of the body.

What is the result?

The spread of infection in your body will stop. Areas of inflammation are localized. Swelling and redness will disappear. The healing process of the affected areas will accelerate. The skin will become smoother and smoother.

Powerful and effective treatment with the Neurodoktor device will quickly eliminate the clinical manifestations of the disease, localize the foci of pathologies, and reduce the dose of drugs. This will allow you to live a full life and forget about your illness forever.

Your body will receive a powerful impetus to recover and fight the infection and will much more easily tolerate the acute phase of the disease. You can avoid the appearance of aesthetic defects and will return to your usual way of life much faster.

Do you need effective treatment, but still have doubts?

The Neurodoc is today considered one of the most effective methods of treating diseases of a very diverse etiology. It goes well with traditional methods of treatment and enables the body to recover faster. Today, the Neurodoc apparatus is:

    A treatment method that received the Nobel Prize in Physiology or Medicine.The history of the device has more than 20 years.Neurodoc takes part in medical exhibitions around the world.The press writes about the Neurodoktor apparatus (such publications as KP and others).Thousands of people in 26 countries use the Neurodoc.It is produced in Russia at the enterprises of the military-industrial complex.It goes well with various medications, without causing side effects.The device has no contraindications.

Use the device "Neurodoktor"

It should be remembered that treatment with the device Neurodoc it is necessary to carry out only after making an accurate diagnosis and this does not mean that it is necessary to stop the medical treatment of hypertension or any other prescribed by a doctor.

* Discount is valid only with 7 by 31 January

and take the device for a test period
30 days

Do you want to personally communicate with those whom the Neurodoc helped?

Call our office at +7 (495) 108-43-90 and we will give you the contacts of these people.

ATTENTION! ADVERTISING CAMPAIGN!

Order NEURO DOCTOR today and get 3 bonuses:

free delivery in Russia

5 year extended warranty

free trial period of 30 days *

For all customers there is a 100% money back guarantee!

If at the end of 30 days you are not satisfied with the result of the treatment, we will refund you 100% of the money paid for the device. Without talking and without any conditions ..

Licenses and certificates

Los Angeles, US, 90101, Bukowski

Anapa, Russian Federation, 353450, Rashidova

Gagarin, Russian Federation, 215010, Turchin

Odessa, UA, 65003, Grinevich

Gelendzhik, RF, 353460, Rudko

Pavlovsk, Russian Federation, 196620, Sanina

Kaunas, LT, 48101, Adamkute

Kaliningrad, Russian Federation, 236004, Kudryavtsev

Abakan, Russian Federation, 655012, Gaeva

Yekaterinburg, Russian Federation, 620141, Chervets

Hamburg, DE, 21149, Dietmar

Kaluga, Russian Federation, 248011, Zaitseva

Tel Aviv, IL, 61231, Granovich

Saratov, Russian Federation, 410031, Vardanyan

Kursk, Russian Federation, 305044, Lobanov

Plovdiv, BG, 4000, Vaganov

Vsevolozhsk, Russia, 188640, Shepeleva

Zataysk, RF, 649002, Karubin

Kiev, UA, 03150, Velichko

Stavropol, RF, 355020, Guzeeva

Yelets, Russian Federation, 399788, Patrshev

Taldykorgan, KZ, 040001, Jamaev

Arkhangelsk, Russian Federation, 163060, Zhurbin

Makhachkala, RF, 367015, Karimov

Engels, Russian Federation, 413123, Zhitkovsky

Tomsk, Russian Federation, 634031, Smirnov

Los Angeles, US, 90101, Bukowski

Anapa, Russian Federation, 353450, Rashidova

Gagarin, Russian Federation, 215010, Turchin

Odessa, UA, 65003, Grinevich

Gelendzhik, RF, 353460, Rudko

Pavlovsk, Russian Federation, 196620, Sanina

Kaunas, LT, 48101, Adamkute

Kaliningrad, Russian Federation, 236004, Kudryavtsev

Abakan, Russian Federation, 655012, Gaeva

Yekaterinburg, Russian Federation, 620141, Chervets

Hamburg, DE, 21149, Dietmar

Kaluga, Russian Federation, 248011, Zaitseva

Tel Aviv, IL, 61231, Granovich

Saratov, Russian Federation, 410031, Vardanyan

Kursk, Russian Federation, 305044, Lobanov

Plovdiv, BG, 4000, Vaganov

Vsevolozhsk, Russia, 188640, Shepeleva

Zataysk, RF, 649002, Karubin

Kiev, UA, 03150, Velichko

Stavropol, RF, 355020, Guzeeva

Yelets, Russian Federation, 399788, Patrshev

Taldykorgan, KZ, 040001, Jamaev

Arkhangelsk, Russian Federation, 163060, Zhurbin

Makhachkala, RF, 367015, Karimov

Engels, Russian Federation, 413123, Zhitkovsky

Tomsk, Russian Federation, 634031, Smirnov

Los Angeles, US, 90101, Bukowski

Anapa, Russian Federation, 353450, Rashidova

Gagarin, Russian Federation, 215010, Turchin

Odessa, UA, 65003, Grinevich

Gelendzhik, RF, 353460, Rudko

Pavlovsk, Russian Federation, 196620, Sanina

Kaunas, LT, 48101, Adamkute

Kaliningrad, Russian Federation, 236004, Kudryavtsev

Abakan, Russian Federation, 655012, Gaeva

Yekaterinburg, Russian Federation, 620141, Chervets

Hamburg, DE, 21149, Dietmar

Kaluga, Russian Federation, 248011, Zaitseva

Tel Aviv, IL, 61231, Granovich

Saratov, Russian Federation, 410031, Vardanyan

Kursk, Russian Federation, 305044, Lobanov

Plovdiv, BG, 4000, Vaganov

Vsevolozhsk, Russia, 188640, Shepeleva

Zataysk, RF, 649002, Karubin

Kiev, UA, 03150, Velichko

Stavropol, RF, 355020, Guzeeva

Yelets, Russian Federation, 399788, Patrshev

Taldykorgan, KZ, 040001, Jamaev

Arkhangelsk, Russian Federation, 163060, Zhurbin

Makhachkala, RF, 367015, Karimov

Engels, Russian Federation, 413123, Zhitkovsky

Tomsk, Russian Federation, 634031, Smirnov

The reason for the appearance of panniculitis

Among the reasons why panniculitis appears, experts call the penetration of subcutaneous fat through the areas of skin damage of staphylococcus and streptococcus bacteria. Among the causes of panniculitis, experts call the combined effect of pathogenic microflora and such factors as:

  • injuries in the form of burns, scratches, abrasions, frostbite, bites, etc.,
  • intravenous drug use,
  • the patient’s overweight
  • diseases that reduce the work of the body's defense system,
  • dermatological diseases
  • the tendency of subcutaneous fat to the appearance of cracks that occur during the development of edema of this area,

Among other reasons for the appearance of panniculitis, experts call toxic damage to the kidneys, liver, metabolic disorders, surgical intervention, after which there was a trace in the form of scar tissue.

How to treat panniculitis

After a thorough examination and diagnosis, depending on the stage and type of pathology, the doctor recommends a list of measures on how to cure panniculitis. The complex therapy of a pathology prescribed by a doctor may include:

  • injection of glucocorticoids into the area of ​​individual nodular formations,
  • taking antioxidants in the form of vitamins of group C, E and non-steroidal anti-inflammatory drugs,
  • cytostatics prescribed for therapy in clusters of nodular formations and infiltrative species,
  • the use of hepatoprotectors prescribed to normalize the liver of the patient,
  • taking medications from the group of analgesics prescribed by the therapist in the presence of pronounced pain,
  • taking a course of taking biologically active substances and immunostimulants,
  • the use of physiotherapy methods, including laser treatment, UHF, phonophoresis, treatment with ultrasound and magnetotherapy.

Surgical intervention for panniculitis is not prescribed, because if there are a large number of possible side effects, there is a low probability of eliminating the formation without further manifestation in another area of ​​the subcutaneous fat layer. In the case of a prolonged lack of effect from the use of conservative therapy, among the methods of how to treat panniculitis, the doctor may recommend a blood transfusion.

Stages and degrees of panniculitis

Therapists distinguish between idiopathic, visceral and secondary degrees of panniculitis, while in the second case, lipid lesions in the pancreas, liver and kidneys are observed, and in the latter case, the disease progresses with the use of medications, the presence of other pathologies or disorders in the protective system of the body . For the secondary variety of the disease, specialists distinguish such forms of pathology as disorders of lupus, steroid, cold, immunological, crystalline, enzymatic, drug type. In addition, doctors distinguish acute, subacute, chronic and recurrent stages of panniculitis. Moreover, the first is characterized by the unpredictable nature of the course and, in some cases, can be fatal. In contrast, the subacute and chronic stages of the pathology in most cases have a good prognosis for recovery.

Differential diagnosis

Diagnosis The rationale for differential diagnosis Surveys Diagnosis exclusion criteria
Superficial migratory thrombophlebitis
Numerous linearly located seals on the lower, less often - upper limbs. The formation of ulcers is not observed.
USDG of vessels of the lower and upper extremities.
Consultation of a vascular surgeon.
The presence of blood clots and occlusions along the vessels
Sarcoidosis The recurrent nature of UE, shortness of breath, lung damage and mediastinal lymphadenopathy, articular syndrome.Panoramic radiography of the respiratory system,
Skin and biopsy
muscle flap
CT of the lungs
Functional tests - spirography, bodyplethysmography
The presence of sarcoid epithelioid cell granulomas without caseous decay during morphological examination of the skin.
Inductive Tuberculosis, or Bazin Erythema The recurrent nature of UE, shortness of breath, hemoptysis, focal or infiltrative damage to the lungs, fever.Survey radiography of the respiratory system.
CTG of the lungs.
Musculoskeletal flap biopsy.
Intradermal tuberculin test.
The presence of sarcoid epithelioid cell granulomas without caseous decay during morphological examination of the skin.
Erysipelas Erythematous asymmetric inflammation of the skin with clear hyperemic borders, with a roller along the periphery of the inflammatory focus. The edges of the plot are uneven, resembling the outlines of a geographical map. Lymphangitis and regional lymphadenitis, the appearance of blisters, and fever are characteristic.Connection with streptococcal infection, ASL "O", ASA, AGR.
Infectionist consultation.
Asymmetric lesion, bright red rash, clear boundaries, confluent rash, association with streptococcal infection.
Behcet's Disease The presence of aphthous stomatitis, genital ulcers, uveitis, pseudopustular rash, venous and arterial thrombosis.HLAB51, consultation of an ophthalmologist, gynecologist, dermatologist.
FGDS
Recurrent aphthous stomatitis, ulcerative lesions of the genital mucosa, uveitis, gastrointestinal ulceration, arterial and venous thromboses.
Lupus Panniculitis Knotty painful rashes on the face, shoulders (butterfly) on the face, arthritis, nephrotic syndrome.Immunological research (ANA, ENA, Antibodies to ds-DNA, ANCA, RF, cryoglobulins)
AFL (lupus anticoagulant, antibodies to cardiolipin) - positive for ANA,
daily proteinuria
Positiveness for antibodies to ds-DNA, ANA, lupus anticoagulant, antibodies to phospholipids, proteinuria, hematuria, polyserosites.
Crohn's disease Diarrhea with mucus and blood, aphthous stomatitis, non-destructive arthritis.Calprotectin, colonoscopy, gastroenterologist consultation.The presence of ulcerative lesions of the gastrointestinal mucosa, increased calprotectin.

Manifestations of the skin

Round-shaped nodes appear in the subcutaneous fat, rapidly increasing in size and reaching from 1-2 cm to 3-5 cm in diameter, often painful. The nodes have the property to be distributed symmetrically on the patient's body. The nodes are localized in the subcutaneous fat of the trunk, mammary glands, buttocks, and thighs. Most often found on the hips. The skin above them is hyperemic, swollen, with a bluish tint. Multiple rashes are usually noted, and with a tight arrangement, the nodes can merge.

The duration of the existence of nodes varies: from fast spontaneous evolution with full resolution within 1-2 weeks to existence within several months and even years. The nodes gradually disappear without a trace or leave behind a slight sagging, atrophicity and hyperpigmentation of the skin. It is possible to melt the nodes and open them with the release of an oily liquid. The resulting ulcers heal slowly. Sometimes there is sclerotherapy of nodes with subsequent calcification.

Diagnosis and histology of tissue in the disease

The diagnosis of Weber-Christian disease is confirmed by the characteristic histological picture in biopsy specimens of nodes.

According to W. F. Lever, pathomorphologically, the process goes through three successive stages.

  • The first stage is island-inflammatory.

At this stage, nonspecific inflammatory infiltrates formed by polymorphonuclear leukocytes, lymphocytes and histiocytes are detected between dystrophically altered fat cells - adipocytes. This stage is fleeting and is rare in histological examination.

  • The second stage is macrophage.

There is a peculiar histiocytic reaction: histiocytes take the form of macrophages, often multinucleated, with foamy cytoplasm (“lipophages”) (“foam cells”). They penetrate into the fat cells and absorb them, so that in some cases the fat cells turn out to be completely replaced by “lipophages,” necrotic foci form in places.

  • The third stage is fibroblastic.

At this stage, lymphocytes and fibroblasts fill the areas of fat cell necrosis, collagen fibers are fibrosed, and gradually the adipose tissue is replaced by scar tissue, sometimes with the deposition of calcium salts.

Drugs (active substances) used in the treatment
Amoxicillin (Amoxicillin)
Acyclovir (Acyclovir)
Benzathine benzylpenicillin (Benzathine benzylpenicillin)
Betamethasone (Betamethasone)
Hydrocortisone (Hydrocortisone)
Dexamethasone (Dexamethasone)
Diclofenac (Diclofenac)
Clavulanic acid (Clavulanic acid)
Clobetasol (Clobetasol)
Meloxicam (Meloxicam)
Methylprednisolone (Methylprednisolone)
Mycophenolic acid (Mycophenolate mofetil) (Mycophenolic acid (Mycophenolate mofetil))
Omeprazole (Omeprazole)
Pantoprazole (Pantoprazole)
Prednisolone (Prednisolone)
Fexofenadine (Fexofenadine)
Cetirizine (Cetirizine)
Cyclosporine (Cyclosporine)
Cyclophosphamide (Cyclophosphamide)

Treatment (outpatient clinic)

TREATMENT TACTICS AT THE OUTDOOR LEVEL 1,4-8,11,19,20,21
UE patients are treated primarily on an outpatient basis.If there is no effect on an outpatient stage, within 10 days in the case of an acute course of UE, it is necessary to send it to hospital treatment. With this disease, complex therapy is effective. The tactics of using drugs are always determined by the form of the disease and the nature of its course. Comprehensive treatment includes both non-drug and drug treatment.
The main method of treating UE is the elimination of a provoking factor. The intake of drugs that can induce UE should be discontinued taking into account the assessment of the risk-benefit ratio and on the basis of the consultation of the doctor who prescribed these drugs. In relation to infections and neoplasms that may underlie the development of UE, appropriate treatment should be carried out.
Drug therapy is usually symptomatic, since in most cases the pathological process is spontaneously resolved. Patients should be warned about the possible activation of the process within 2-3 months. Relapses of UE develop in 33–41% of cases, the probability of their development increases if the trigger factor of the disease is unknown 12, 13.
The treatment regimen depends on the stage of diagnosis of the underlying disease and the effectiveness of treatment.
The main drugs in the treatment of UE are antibacterial drugs in the presence of streptococcal infection, antiviral drugs in the presence of viral load, anti-inflammatory drugs - non-steroidal anti-inflammatory drugs, glucocorticosteroids, angioprotectors, antioxidants.

Non-drug treatment:
· Mode: UE patients are prescribed a half-bed regimen.
· Diet:table number 15, with sufficient protein and vitamins, with the elimination of extractive substances.
· Lifestyle changes: abandonment of bad habits, avoidance of hypothermia, intercurrent infections, significant mental and physical stress.

Medication 7.11, 20, 21:
Therapy regimens depend on the stage of diagnosis of the underlying disease and the effectiveness of treatment.

UE therapy steps7,11, 20, 21.
At stage I, before the examination of the patient (initial patient intake)reception needed non-steroidal anti-inflammatory drugs (NSAIDs) (to reduce inflammatory changes in the area of ​​nodes):
· Diclofenac sodium 150 mg per day in 2-3 doses orally for 1.5-2 months (UD-D) 7.11,
or
· Meloxicam 15 mg per day intramuscularly for 3 days, then 15 mg per day orally for 2 months (UD-D) 11.14.
Local therapy on the site of the node (with analgesic, absorbable, anti-inflammatory):
· Applications with 33% dimethyl sulfoxide solution 2 times a day for 10-15 days
or
· Clobetasol adipropionate 0.05% ointment 2 times a day on the lesions for 1 month.

Stage II - the underlying disease is verified (patient re-admission)
Treatment of stage I + continues, depending on the cause of UE:
In VUE associated with β-streptococcal infection of group A of the pharynx (tonsillitis, pharyngitis) with tonsillitis or tonsillitis, antibacterial drugs are prescribed: benzathinebenzylpenicillin 2.4 million units intramuscularly once every 3 weeks for 6 months (UD - D) andwhetheramoxicillin + clavulanic acid 1000 mg 2 times a day for 10 days (UD - D).
VUE associated with mycoplasma or chlamydial infection:
Doxycycline 0.1 g 2 times a day for 7 days
or
Clarithromycin 0.25 g 2 times a day for 7 days.
VUE atmixtinfections: antibacterial drugs are prescribed (see above) and / orVirostatics
Acyclovir 200 mg 5 times a day for 7-10 days (UD - D).
Or
Valaciclovir 500 mg 2 times a day for 7-10 days (UD - D).
With VUE due to allergic effects:
· Cancellation of a provocative drug or chemical agent, etc.
· Systemic antihistamines:
-Fexofenadine 180 mg per day orally for 2 weeks (UD - D)
or
-cetirizine 1 mg per day by mouth for 2 weeks.
VUE for rheumatic diseases, Crohn’s disease, etc .:
Therapy of the underlying disease is being carried out.

Stage III - carried out at lack of effect from therapy of stages I and II, torpid course of UE.
In the absence of infections as the cause of UE, it is necessary to repeat the examination complex in order to clarify the underlying disease, followed by consultation with a rheumatologist, pulmonologist, gastroenterologist, etc.
Glucocorticoids of systemic action (with anti-inflammatory purpose):
· Prednisone 5-15 mg per day orally for 1.5-2 months, then reduce ¼ tablets once every 7 days to 10 mg per day, then ¼ tablets once every 14 days to 5 mg per day and ¼ tablets once every 21 days until cancellation

PVC treatment not completely developed and carried out mainly empirically. Drug therapyPVC 7.11, 21 depends on the form of the disease
Knotty shape:
· NSAIDs (diclofenac sodium, lornoxicam, nimesulide, etc.) for 2-3 weeks,
· Glucocorticoids - prednisolone 10-15 mg / day for 3-4 weeks, then switch to a maintenance dose with a gradual decrease in dose by 2.5 mg to a maintenance dose of 2.5-5 mg.
With single nodes, a good therapeutic effect is noted from the introduction of glucocorticoids by the method of chipping lesions without the development of atrophy of the pancreas. Moreover, course doses of HA are significantly lower than with oral administration 1–4.
· aminoquinoline preparations (hydroxychloroquine 400-600 mg / day),
· application therapy (creams with clobetasol, hydrocortisone, heparin).

Plaquethe form:
Glucocorticoidsin average therapeutic doses - prednisolone 20-30 mg / day. and the appointment of cytostatic drugs: cyclophosphamide, methotrexate, azathioprine.

The list of essential drugs (having a 100% probability of use):

Drug group International Nonproprietary Name Mode of application Level of evidence
Antibacterial drugs Benzatinabenzylpennicillin2.4 million units / m once a week for 6 months.UD –D 8,9,15,18,19
Amoxicillin + Clavulanic Acid
625 mg 3 times a day for 10 days. Orally.UD –D 8,9,15,18,19
Antiviral drugs Acyclovir200 mg 5 times a day for 7-10 days Orally.UD –D 8,9,15,18,19
Nonsteroidal anti-inflammatory drugs Diclofenac Sodium
or
50 mg each. 1-2 times / day 2 weeksUD –D 8,9,15,18,19
Meloxicam15 mg once a day for 2 weeksUD –D 8,9,15,18,19
Systemic glucocorticosteroids Methylprednisolone
or
8-16 mg per day orally until stabilizationUD –D 8,9,15,18,19
Prednisone
10-20 mg per day orally until stabilizationUD –D 8,9,15,18,19
Local external glucocorticosteroids Hydrocortisone 5%Outwardly, 2 times a day until the disappearance of nodesUD –D 8,9,15,18,19
Drug group International Nonproprietary Name Mode of application Level of evidence
Antihistamines Fexofenadine
or
180 mg per day orally for 2 weeks.UD –D 8,9,15,18,19
Cetirizine10 mg Once a day 10 daysUD –D 8,9,15,18,19
Antisecretory drugs Omeprazole
or
40 mg per day. Orally while taking NSAIDs or GCSUD –D 8,9,15,18,19
Pantoprazole40 mg per day against the background of the entire intake of NSAIDs or corticosteroidsUD –D 8,9,15,18,19

Surgical intervention: not.

Further maintenance:
· All patients are subject to follow-up:
· In the case of an acute course of the disease during the year with a preventive examination of the doctor 2 times a year, with an examination to identify the cause of the disease (in case of unknown), or monitor the factors identified as the cause of the panniculitis with the appointment of antioxidants (vitamin E),
· In the case of a chronic course of the disease, a long-term follow-up with a preventive examination of the doctor 2 times a year, with an examination to identify the cause of the disease (if not identified), or to monitor the factors identified as the cause of the panniculitis with the appointment of antioxidants (vitamin E), as well as control treatment with the correction of complications of drug therapy.

Indicators of treatment effectiveness:
· Complete involution of nodes,
Lack of relapse.

Treatment (hospital)

STATIONARY TREATMENT TACTICS 1,4,8, 9,11,20,21: patients who have no effect of outpatient treatment, as well as in the case of subacute and chronic course, in which parenteral administration of glucocorticosteroids are considered, are hospitalized.
Patients with PVC are subject to hospitalization with an infiltrative form, in the case of a course of panniculitis with systemic manifestations (fever, signs of pancreatic pancreatic injury retroperitoneal space).

Patient observation map, patient routing:

Non-drug treatment:
· Mode 2,
· Table No. 15, a diet with sufficient protein and vitamins,
· For eating disorders: hypoallergenic diet, determination of body mass deficiency.

Diet Selection:
With aspiration: to clarify the presence of pneumonia, swallowing disorders.
Choose a position for feeding, a decrease in salivation (see in the section on drug treatment the introduction of botulinum toxin A into the salivary glands),
With gastroesophageal reflux: control of pain, posture during feeding, increased muscle tone. The selection of a hypoallergenic diet with dietary fiber, in the presence of esophagitis or gastritis (taking omeprazole) is possible through a gastric tube or gastrostomy,
· If treatment of gastroesophageal reflux is not effective, laparoscopic fundoplasty.

Drug treatment

Infiltrative Form: Glucocorticoids in a daily dose of 1-2 mg / kg per day until the condition stabilizes along with the use of cytostatic drugs: azathioprine 1.5 mg / kg, mycophenolate mofetil (in combination with HA) - 2 g / day cyclosporin A ≤5 mg / kg / day up to the complete abolition of glucocorticoids.

The list of essential drugs (having a 100% probability of use):

Drug group International Nonproprietary Name Mode of application Level of evidence
Antibacterial drugs Benzatinabenzylpennicillin2.4 million units / m once a week for 6 months.UD –D 8,9,15,18,19
Amoxicillin + Clavulanic Acid
625 mg 3 times a day for 10 days. Orally.UD –D 8,9,15,18,19
Antiviral drugs Acyclovir200 mg 5 times a day for 7-10 days Orally.UD –D 8,9,15,18,19
Nonsteroidal anti-inflammatory drugs Diclofenac Sodium
or
50 mg each. 1-2 times / day 2 weeksUD –D 8,9,15,18,19
Meloxicam15 mg once a day for 2 weeksUD –D 8,9,15,18,19
Systemic glucocorticosteroids Methylprednisolone
or
iv 250-1000 mg 1 time per day. 3 days, then switching to oral administration of 8-16 mg per day orally for the entire stay in the hospitalUD –D 8,9,15,18,19
Prednisone
30-180 mg
1 time per day, iv, i / m 3-5 days, then switch to oral administration of 10–20 mg per day orally all 1 time in hospital
UD –D 8,9,15,18,19
Local external glucocorticosteroids Hydrocortisone 5%
or
Dexamethasone 0.025%
or
Clobetasolapropionate 0.05%
or
Betamethasone novalerate
Outwardly, 2 times a day during the entire hospital stayUD –D 8,9,15,18,19
Immunosuppressive drugs Cyclophosphamide
or
200 mg, powder for solution preparation
200-600 gr 1 time for the entire stay in the hospital
UD –D 8,9,15,18,19
Cyclosporin A
or
Inside
25 mg., 50-100 mg
1-2 times a day all the time in the hospital
UD –D 8,9,15,18,19
Mycophenolate amofetil2000 mg per day orally, all the time in the hospitalUD –D 8,9,15,18,19
Drug group International Nonproprietary Name Mode of application Level of evidence
Antihistamines Fexofenadinyl
or
180 mg per day orally for 2 weeks.UD –D 8,9,15,18,19
cetirizine10 mg Once a day 10 daysUD –D 8,9,15,18,19
Antisecretory drugs Omeprazole
or
40 mg per day. Orally. For the entire time of taking NSAIDs or GCSUD –D 8,9,15,18,19
Pantoprazole40 mg per day against the background of all NSAIDs orUD –D 8,9,15,18,19

Surgical intervention: not.

Further maintenance:
· After discharge from the hospital, the patient continues to take glucocorticosteroids and cytostatic drugs at a dose recommended by the hospital doctor with a gradual decrease in the dose of glucocorticosteroids until the clinical and laboratory stabilization of the condition (disappearance of nodes, normalization of acute phase inflammation), followed by a decrease in the dose of glucocorticoids by 2.5 mg of prednisone every 2 weeks to 10 mg, then a slower dose reduction of 1.25 mg of prednisone every 2-2 weeks. The entire period of lowering the dose of GCS is accompanied by the administration of a cytostatic drug prescribed in the hospital. The appointment of cytostatics is 1-2 years long. With continued administration of corticosteroids and cytostatics, a general blood test with platelet counts, liver tests, blood creatinine should be performed to monitor the side effects of these drugs.
· Patients should visit the doctor of the outpatient clinic 2 weeks after discharge from the hospital, then monthly - 3 months and 1 time in 3 months for the entire follow-up period - while the patient is taking cytostatic therapy. If you stop taking cytostatics, in the case of a stable improvement in the patient's condition, follow-up (see section 3.4).

Indicators of treatment effectiveness:
· Achieving minimal activity and / or clinical and laboratory remission,
· The absence of complications with mesenteric panniculitis,
· Involution of nodes,
Lack of relapse.

Hospitalization

INDICATIONS FOR HOSPITALIZATION WITH INDICATION OF TYPE OF HOSPITALIZATION

Indications for planned hospitalization:
Inefficiency of outpatient therapy,
Relapses of new rashes,
Severe systemic manifestations (fever),
Mesenteric lobular panniculitis.

Indications for emergency hospitalization:not.

Sources and literature

  1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2017
    1. 1) Blake T. Manahan M., Rodins K. Erythema nodosum - a review of an uncommon panniculitis. Dermatol. Onine J. 2014, 20 (4): 22376. 2) Belov B.S., Egorova O.N., Radenska-Lopovok S.G. et al. Erythema nodosum: vasculitis or panniculitis? Rheumat., 2009, (3): 45–49. 3) RequenaL., YusE.S. Erythemanodosum.Semin.Cutan.Med.Surg, 2007,26: 114–125. 4) Gilchrist H., Patterson J.W. Erythema nodosum and erythema induratum (nodular vasculitis): diagnosis and management. DermatolTher 2010, 23: 320–327. 5) Cribier B., Caille A., Heid E., Grosshans E. Erythemanodosum and associated diseases. A study of 129 cases. IntJ Dermatol 1998.37: 667–672. 6) Schwartz R.A., Nervi S.J. Erythema nodosum: a sign of systemic disease. Am Fam Physician 2007.75: 695-700. 7) Belov B.S., Egorova O.N., Karpova Yu.A., Balabanova R.M. Erythema nodosum: modern aspects. Scientific and practical. 2010, 4: 66–72. 8) Vermel A.E. Erythema nodosum in the clinic of internal diseases. Klin.med., 2004,4,4-9. 9) Belov B.S., Egorova O.N., Karpova Yu.A. and other Nodular erythema (clinical lecture). ConsiliumMedicum: Dermatology. 2010.1: 3-6. 10) Mert A., Ozaras R., Tabak F. et al. Erythema nodosum: an experience of 10 years. Scand J Infect Dis 2004: 36: 424-427. 11) Mert A., Kumbasar H., Ozaras R. et al. Erythema nodosum: an evaluation of 100 cases. ClinExpRhematol, 2007: 25: 563-570. 12) Balabanova R.M., Karpova Yu.A. Meloxicam: prospects for use in erythema nodosum. Modern Rheumatology 2010, (1): 41–44. 13) Belov B.S., Egorova O.N., Balabanova R.M. Idiopathic erythema nodosum and pregnancy: case description. Modern Rheumatology 2009, (2): 56–59. 14) Kosheleva, N.M., Khuzmieva S.I., Alekberova Z.S. Systemic lupus erythematosus and pregnancy. Scientific Pract. Rheumatology, 2006.2: 52-59. 15) Belov B.S., Egorova O.N., S.G. Radenska-Lopovok. Panniculitis in the practice of a rheumatologist (lecture). Scientific and Practical Rheumatology 2013, 51 (4): 407-415. 16) Federal clinical guidelines for the management of erythema nodosum. Moscow, 2016 .19 p. 17) Szyszymar B., Gwiezdzinski Z. Treatment of recurrent panniculitsfebrilisnonsuppurativa with methotrexate. PrzeglDermatol 974.61: 623-7. 18) Mashkunova O.V. "Comparative evaluation of complex pathogenetic therapy of erythema nodosum in rheumatological practice." The collection of scientific works “Actual problems of modern rheumatology”, issue No. 30, Volgograd, 2013. - P. 63-65. 19) Egorova O.N., Belov B.S., Karpova Yu.A. "Spontaneous panniculitis: modern approaches to treatment." Scientific and Practical Rheumatology 2012, 54 (5): 110-114 20) Mavrikakis J., Georgiadis T., Fragiadaki K., Sfikakis P. Orbitallobularpanniculitis in Weber-Christian disease: sustained responseto anti-TNF treatment and review of the literature. SurvOphthalmol 2010.55 (6): 584–89. 21) Al-Niaimi F., Clark C., Thorrat A., Burden A.D. Idiopathic lobularpanniculitis: remission induced and maintained with infliximab.Br J Dermatol 2009,161: 691–2.

Information

ORGANIZATIONAL ASPECTS OF THE PROTOCOL

List of protocol developers with qualification data:
1) Olga Mashkunova - candidate of medical sciences, associate professor of the Department of Internal Medicine No. 4, rheumatologist of the Republican State Pedagogical University at the Perm State Pharmacological Institute “Kazakh National Medical University named after S.D. Asfendiyarova. ”
2) Kalieva Gulnara Aitkazievna - candidate of medical sciences, associate professor of the department of general medical practice No. 1 of the Republican State Pedagogical University at the Perm State Pedagogical University Kazakh National Medical University named after S.D. Asfendiyarova. ”
3) Saipov Mamurzhan Kamilovich - rheumatologist, head of the department of rheumatology of the CGP at the PCV "Regional Clinical Hospital", Shymkent.
4) Yukhnevich Ekaterina Aleksandrovna - acting Associate Professor at the Department of Clinical Pharmacology and Evidence-Based Medicine of the Republican State Pedagogical University at the Perm State University “Karaganda State Medical University”, clinical pharmacologist.

Indication of no conflict of interest: not.

Reviewers: Gabdulina Gulzhan Khamzinichna - Candidate of Medical Sciences, Associate Professor of the Department of Outpatient Therapy of the Republican State Pedagogical University at the Perm State University “Kazakh National Medical University named after S.D. Asfendiyarova. ”

Indication of the conditions for revising the protocol: revision of the protocol 5 years after its entry into force and / or with the advent of new methods of diagnosis / treatment with a higher level of evidence.

Pin
+1
Send
Share
Send

Watch the video: Inflammatory autoimmune diseases of the skin (March 2020).