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

• Poststeroid Panniculitis
• PSP (Post-Steroid Panniculitis)

What is Post-Steroid Panniculitis? (Definition/Background Information)

• Post-Steroid Panniculitis (PSP) is the development of subcutaneous nodules occurring after a few days to several weeks following the sudden withdrawal of high-dose steroid therapy. The term ‘panniculitis’ indicates an inflammation of fat (adipose) tissue
• Post-Steroid Panniculitis is extremely rare and is usually observed in children. It may be described as a potential complication in individuals undergoing systemic corticosteroid treatment for other medical conditions such as rheumatic fever, brainstem glioma, or nephrotic syndrome
• The condition causes the presence of generally painless and reddish subcutaneous plaques or nodules on the face, neck and trunk. Usually, no other severe symptoms or adverse complications have been reported from Post-Steroid Panniculitis
• In many, the condition does not require any treatment and it gets better on its own. The prognosis of Post-Steroid Panniculitis is typically excellent. The condition may be avoided by slowly tapering the administration of systemic steroids, instead of a rapid withdrawal

Who gets Post-Steroid Panniculitis? (Age and Sex Distribution)

• Post-Steroid Panniculitis is a highly-infrequent condition that is predominantly observed in children. However, individuals of all age groups may be affected
• No gender preference is noted and both males and females are affected
• No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Post-Steroid Panniculitis? (Predisposing Factors)

• Individuals undergoing steroid therapy with high-dose medication for any health condition may be at risk for Post-Steroid Panniculitis following a sudden stoppage of the medication

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s 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 Post-Steroid Panniculitis? (Etiology)

• Post-Steroid Panniculitis (PSP) develops when treatment using high-dose steroids is suddenly discontinued in individuals undergoing systemic steroid therapy for other medical condition
• Corticosteroid courses should not be abruptly stopped because the normal production of cortisol by the adrenal glands can be suppressed enough to be life-threatening
• However, the exact mechanism of development of PSP is unknown

What are the Signs and Symptoms of Post-Steroid Panniculitis?

The signs and symptoms of Post-Steroid Panniculitis may include:

• The presence of subcutaneous plaques and nodules on several parts of the body
• The skin over the plaques/nodules may have a slightly reddish or purplish discoloration
• Typically, the cheeks, posterior neck, upper chest and upper back, arms and legs are known to be involved
• The condition is seen to develop within a few days (1-3 days) or following several weeks (4-5 weeks), after withdrawal of steroid medication
• No pain or itching is generally observed; but, it may occur in a few cases

How is Post-Steroid Panniculitis Diagnosed?

Post-Steroid Panniculitis may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history including evaluation of treatment using high-dose steroids
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin or tissue 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
• A differential diagnosis to exclude the following conditions may be necessary prior to a definitive diagnosis:
  • Cold panniculitis
  • Erythema nodosum
  • Lupus profundus
  • Sclerema neonatorum
  • Subcutaneous fat necrosis of the newborn
  • Traumatic panniculitis
  • Weber-Christian disease

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 Post-Steroid Panniculitis?

In a majority of individuals, no significant complications due to Post-Steroid Panniculitis are noted. However, in some cases, it may present the following complications:

• Cosmetic issues that result in emotional stress
• Bleeding and ulceration of the skin may result in secondary viral or bacterial infections
• If the course of steroids has been of high dose and long duration, the adrenal glands may not be able to produce cortisol at normal levels. This can be life-threatening

How is Post-Steroid Panniculitis Treated?

In many individuals, no treatment is necessary for Post-Steroid Panniculitis, since it is known to resolve spontaneously. If required, the following measures may be considered:

• Symptomatic and supportive therapy
• Topical applications are generally not helpful
• In very severe cases, systemic steroid therapy may have to be resumed to treat Post-Steroid Panniculitis

How can Post-Steroid Panniculitis be Prevented?

Generally, Post-Steroid Panniculitis may be prevented by gradually tapering-off steroid therapy, instead of stopping the treatment abruptly.

What is the Prognosis of Post-Steroid Panniculitis? (Outcomes/Resolutions)

The prognosis of Post-Steroid Panniculitis is typically excellent, since it is a self-limiting condition with no severe symptoms or complications being noted.

Additional and Relevant Useful Information for Post-Steroid Panniculitis:

There are many different types of panniculitis and it has been difficult to obtain an accurate picture of their true incidence, since they may be associated with so many conditions. The different types may include:

• Lupus panniculitis
• Pancreatitis-associated panniculitis
• Alpha-1 antitrypsin deficiency associated panniculitis
• Infective panniculitis