What are the other Names for this Condition? (Also known as/Synonyms)

• Enzymatic Panniculitis
• Pancreatitis-Associated Panniculitis

What is Pancreatic Panniculitis? (Definition/Background Information)

• Pancreatitis Panniculitis is a type of lobular panniculitis with the involvement of the pancreas, which is especially seen in middle-aged and older men
• The risk factors for the condition include acute pancreatitis and pancreatic cancer. There is an involvement of the abdomen, legs, and buttocks, causing joint pain and itching
• Panniculitis is a condition in which inflammation occurs in the subcutaneous tissue, just beneath the skin. The term ‘panniculitis’ indicates ‘inflammation of fat tissue’
• The condition causes painful or painless subcutaneous nodules all over the body; the skin over these nodules may be red in color. The cause of Pancreatitis Panniculitis is unknown
• The condition may also have the involvement of many vital organs such as the heart, lungs, kidneys, intestines, and spleen. Complications may arise from the nodules that include ulceration and bleeding. This can cause scar formation on healing
• The treatment involves the use of medications and steroids, however the prognosis of Pancreatitis Panniculitis depends upon many factors including the underlying condition, the severity of the signs and symptoms, and the organs that are affected

Who gets Pancreatic Panniculitis? (Age and Sex Distribution)

• Pancreatic Panniculitis is observed in middle-aged or older men to a higher degree
• No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Pancreatic Panniculitis? (Predisposing Factors)

The risk factors of Pancreatic Panniculitis include:

• Acute pancreatitis
• Pancreatic cancer
• Increased alcohol consumption
• Recently diagnosed diabetes mellitus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pancreatic Panniculitis?

• The exact cause of Pancreatic Panniculitis is currently unknown
• But, there is an association of pancreatic infection and cancer of the pancreas to the condition

What are the Signs and Symptoms of Pancreatic Panniculitis?

The signs and symptoms of Pancreatic Panniculitis may include:

• The abdomen, buttocks and joints may be affected giving rise to joint pain and pruritus (itching)
• Apart from the pancreas, the pericardium and pleura (causing chest pain and breathing difficulties) may also be involved
• There could be the formation of ascites (fluid in the abdomen)
• Inflammation of the ankle joints
• The nodules are mostly observed in the thighs and lower legs. The nodules appear in a symmetric pattern and may present with or without any pain
• Fever
• Tiredness
• Joint and muscle pain
• Weight loss
• Occasional involvement of other organs resulting in fat around the liver and intestines. When this occurs the signs and symptoms may include nausea and vomiting, abdominal pain, enlarged liver (hepatomegaly)

How is Pancreatic Panniculitis Diagnosed?

Pancreatic Panniculitis may be diagnosed using the following tools:

• Complete physical examination with comprehensive evaluation of medical history
• Blood tests:
  • To detect serum amylase and lipase levels: A normal blood serum amylase and lipase levels would help exclude Pancreatitis-Associated Panniculitis
  • CBC with differentials may show low white cell count and decreased haemoglobin (anemia)
  • Blood electrolyte may reveal abnormal levels
  • Erythrocyte sedimentation rate (ESR) blood test may show increased ESR
  • C-reactive protein blood test may show increased C-reactive protein levels
  • May reveal abnormal liver function test
• Urine tests to check for lipase and amylase levels
• Radiographic studies of the affected region
• Deep skin biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Depending upon the organ involved, the healthcare provider may undertake further studies such as:

• Echocardiogram (for the heart)
• Chest x-ray, CT, or MRI scans
• Abdominal ultrasound, CT, or MRI scans
• Liver function test

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pancreatic Panniculitis?

The complications due to Pancreatic Panniculitis may include:

• The nodules may ulcerate and bleed, resulting to the formation of scars on healing
• Bacterial and fungal infections: The condition may providing a suitable environment for bacteria and fungi to grow and thrive, resulting in secondary infections
• The lesions can last for years resulting in self-image issues, emotional stress, and psychological trauma in some individuals
• If the emotional stress is severe, it may even lead to depression and social isolation

How is Pancreatic Panniculitis Treated?

The treatment of Pancreatic Panniculitis may involve the following measures:

• Treatment of the underlying condition causing Pancreatitis-Associated Panniculitis
• Systemic steroids to control severity of the condition
• Fibrinolytic agents (which are used to prevent the clotting of blood)
• Medications, including antibiotics and antifungals to treat secondary infections (if any)
• Treating the underlying conditions
• Providing reassurance and helping with feelings of stress and anxiety
• Follow-up care with regular screening and checkups are important, since the condition can last for many months and years

How can Pancreatic Panniculitis be Prevented?

Current medical research has not established a way of preventing Pancreatic Panniculitis. However, the severity of the condition may be controlled through continuous medical support and treatment.

• Preventing the underlying condition, if possible, such as controlling diabetes, stopping or decreasing alcohol consumption, etc.
• If the underlying cause is pancreatic cancer, then adequate treatment of cancer can be beneficial
• If the underlying cause is acute pancreatitis, then undertaking appropriate treatment and preventing future episodes of acute pancreatitis is important

What is the Prognosis of Pancreatic Panniculitis? (Outcomes/Resolutions)

• The prognosis of Pancreatic Panniculitis depends upon the underlying condition, the severity of the signs and symptoms, and involvement of the vital organs of the body
• It can be a fatal condition if severe involvement of the heart, lungs, kidneys, or liver occurs

Additional and Relevant Useful Information for Pancreatic Panniculitis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/digestive-center/