Panniculitis poststeroidal T88.7

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Panniculitis post-Steroid Panniculitis; Poststeroid panniculitis; Post-Steroid Panniculitis

History
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Smith & Good, 1956

Definition
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Rare complication after prompt reduction of a high-dose internal corticosteroid treatment. Nodular panniculitis. Occurs 1-35 days after discontinuation.

Etiopathogenesis
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Etiology unknown. The cumulative system dose range for prednisolone administration is between 2.0 and 5.0 g per os or i.v.

Manifestation
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Mainly occurring in children, usually between the 20th month of life and the 14th year of age. Less frequently also with adults.

Localization
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Mostly located on cheeks, chin, arms or trunk.

Clinical features
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Up to 4 cm large, firm, subcutaneous nodules and plates. The skin is red to skin-coloured. Slight hyperthermia. Occasional slight itching. Usually no other symptoms.

Histology
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Lobular panniculitis, with a strong inflammatory response by lymphocytes, macrophages and multinuclear giant cells. Needle-shaped, radially arranged recesses (needle shaved clefts) in the fat cells.

Differential diagnosis
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Therapy
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No causal therapy known and necessary. Recovery in weeks to months, therefore a wait-and-see attitude (especially in mild cases) is justifiable.

External therapy
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Apply non-steroidal anti-inflammatory drugs such as indomethacin (e.g. Amuno gel), ibuprofen (e.g. Dolgit cream) or piroxicam (e.g. Felden-top cream) in a thick layer on lesioned skin, additionally apply hourly compresses with 0.9% saline solution or 2-5% ethanol.

Internal therapy
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As far as possible, avoid systemic glucocorticoids.

Progression/forecast
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Favourable: regression in weeks to months.

Literature
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  1. Llamas-Velasco M et al (2015) Panniculitis with crystals induced by etanerceptsubcutaneous injection. J Cutan Pathol doi: 10.1111/cup.12478
  2. Marovt M et al (2012) Post-steroid panniculitis in an adult. Acta Dermatovenerol Alp Pannonica Adriat 21:77-78
  3. Requena L et al (2001) Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol 45: 325-361
  4. Roenigk HH et al (1964) Poststeroid panniculitis. Arch Dermatol 90: 386-391
  5. Smith RT, Good RA (1956) Sequelae of prednisone treatment of acute rheumatic fever. Clin Res Proc 4: 156-157
  6. Sacchidanand SA et al.(2013) Post-steroid panniculitis: A rare case report. Indian Dermatol Online J 4:318-320

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020