Inflammation of the subcutaneous tissue of the legs treatment. Inflammation of the soft tissues of the leg. Why does he appear

Panniculitis (Pn) are diseases of a heterogeneous nature, which are characterized by pathological changes in subcutaneous fat tissue (SFA). Often these diseases also affect the musculoskeletal system.

What's the problem with diagnostics?

Mon are diverse in their clinical and morphological manifestations, there are a large number of forms of the disease, with criteria that would lead to a common denominator in diagnosing this moment No. Patients with Mon turn to to various specialists precisely because of the polymorphism of clinical symptoms. Such situations lead to an insufficiently rapid diagnosis, and therefore treatment begins untimely.
Attempts at classification

At present, there is no classification that would be uniform for all countries of the world. Some authors offer their vision and organize Pn according to etiology and pathomorphological picture. Thus, septal (SPn) and lobular are now distinguished panniculitis(LPn), that is inflammatory process located in the connective tissue septa and in the lobules of adipose tissue, respectively. Both variants of the disease can be combined with symptoms of vasculitis and occur without it.

Erythema nodosum (UE)

UE is a typical representative of septal panniculitis. The immunoinflammatory process in this pathology is nonspecific. There are many reasons for its appearance:

There are primary and secondary UE. Primary is most often idiopathic. Clinical symptoms that occur with UE are characterized by the condition immune system, etiology of the disease, localization of the pathological focus, as well as prevalence.

UE can be diagnosed only after a carefully collected medical history, patient complaints, based on the clinic and research data, laboratory and instrumental.

Brief description of clinical example No. 1

The patient is 31 years old and has a history of chronic tonsillitis from 15 years and frequent appointments antibiotics for it. In 2009, painful nodes were discovered after another exacerbation of tonsillitis. The nodes were located on the left shin. Treatment was carried out with the glucocorticosteroid hormone dexamethasone, after which positive dynamics were observed. After 3 years, tonsillitis provoked the appearance of 2 more nodes on the legs. After two months of homeopathic therapy, the nodes regressed. At the end of the year there was a relapse again painful formations on the shin.

Upon admission general state satisfactory, normosthenic physique, normal body temperature. Other indicators of examination and laboratory tests were also unchanged.

When palpating the formations on the lower leg, pain is noted. Ultrasound of the node revealed an area of some blurring with increased echogenicity and high content vessels.

The diagnosis made by doctors sounded like erythema nodosum Stages 2-3 and chronic tonsillitis. After treatment with benzylpenicillin, non-steroidal anti-inflammatory drugs, the introduction of a protective regimen and local treatment with clobetasol sodium and heparin ointments, the disease regressed after 21 days. There were no exacerbations of the pathology during the year.
Of the causes of the disease, streptococcal infection is in first place, 9 and the case described above indicates an association of UE (septal panniculitis) with streptococcal infection, in particular with sore throat) is sarcoidosis.

Brief review of clinical case No. 2

A 25-year-old patient was admitted to the hospital with complaints of painful nodular formations on the legs and arms, pain in many joints (ankles, wrists), swelling in them, an increase in body temperature to 39C, and increased sweating.

She became ill on December 7, 2013, when arthritis of the ankle joint first appeared. After 2 days, nodes appeared on the legs, which were sharply painful. Within a few days, a large number of the same formations with symptoms appeared general intoxication(fever, sweating).

After examination by a general practitioner, a diagnosis of probable reactive arthritis was made. Dexamethasone was used for treatment. The effect was positive. However, relapses continued.

According to laboratory data, inflammatory changes were determined in the blood. On CT scan of organs chest increased The lymph nodes and there were signs of chronic. Ultrasound of the node showed a blocky structure, some areas were non-echoic and rich in vessels.

After consultation with a pulmonologist, sarcoidosis of the intrathoracic lymph nodes was diagnosed. Final diagnosis looked like Lefgren's syndrome, sarcoidosis of the chest lymph nodes at stage 1, secondary UE, polyarthritis, febrile syndrome.

The patient was treated with dexamethasone and cyclophosphamide parenterally. Then methylprednisolone was prescribed orally. Cyclophosphamide was also administered weekly, accompanied by a non-steroidal anti-inflammatory drug. The therapy led to positive dynamics of the disease and the patient is currently under medical supervision.

Differential diagnosis of UE

There are many diseases whose clinical picture is similar to the symptoms of UE, so it is necessary to carry out a careful differential diagnosis. If differential diagnosis is carried out incorrectly or at the wrong time, inadequate therapy is prescribed, which leads to prolongation of the disease and the appearance of various complications and deterioration in human quality of life.

Clinical case example No. 3

A 36-year-old female patient came to the hospital for medical care at the beginning of 2014 due to complaints of tightness in the lower leg, which was painful. The patient believes that the disease first appeared in 2012 after (ARVI). Then a painful lump appeared on my shin. Doctors diagnosed thrombophlebitis. Treatment for vascular medicines, physiotherapy was prescribed. The patient completed treatment with positive dynamics. In April 2013, the painful lump appeared again. Conducted laboratory research which did not reveal inflammatory changes. Ultrasound of the veins revealed insufficiency of the perforating veins of the leg. The patient was sent for consultation to NIIR named after. V.A. Nasonova”, where during the examination a lump was discovered on the lower leg. Laboratory and instrumental studies within normal limits. On ultrasound internal organs some diffuse changes pancreas and liver. Ultrasound of the node shows microvascularization, lumpiness of the structure and thickening of the pancreas.
After all examinations and consultations, a diagnosis of lobular panniculitis, chronic course, lipodermatosclerosis. Varicose veins. Chronic venous insufficiency class IV.

The patient was treated with hydroxychloroquine due to low disease activity. A month later, the dynamics of the disease are positive.

Discussion of case features

We have presented to your attention 3 different cases differential diagnosis, which are very common at the moment.

In the first patient after streptococcal infection On the background of antibiotics and anti-inflammatory drugs, the disease regressed. Moreover, let us note the color dynamics of formations on the skin: a pale red color at the beginning to a yellow-green color at the end of the disease, the so-called symptom of bruise bloom.

For UE, this dynamics is very typical and even late stages his illness can be determined. The nodules themselves disappear without a trace after 3-5 weeks. No skin atrophy or scars are observed.
At the same time with skin manifestations also manifests articular syndrome. Pain and swelling in the joint area occur in half of patients with UE. The most common lesion is the glenostop joints. Regression of arthritis is observed within six months. Such patients do not develop heart damage, as with rheumatism, even though joint pain appears after the primary streptococcal infection.

If patients with UE have a background valvular pathology heart disease does not worsen. In this regard, we can say that UE is not a reflection of the activity of the rheumatic process.

UE and sarcoidosis

Against the background of sarcoidosis, UE has features of its course and manifestations:

swelling of the legs, which often precedes UE;
severe joint pain;
There are quite a lot of skin compaction elements and they are extremely common, and each element is capable of merging with another similar unit;
localization of nodes mainly in the area of the legs;
the dimensions of the elements are large, more than 2 cm in diameter;
V laboratory tests there may be an increase in the titer of antibodies to antistreptolysin-O and to yersinia;
damage to the respiratory tract with symptoms such as shortness of breath, chest pain, cough.

UE (septal panniculitis), hilar lymphadenopathy, fever, and joint involvement are suggestive of Löfgren's syndrome. Despite this, enlarged lymph nodes can also occur with

Cellulite can develop anywhere on the body. In children, it predominantly develops around anus and on the face, and in adults - on the legs, arms and face.

The area of skin affected by bacteria becomes red, swollen, swollen, hot to the touch, and painful when touched. Sometimes blisters appear on the surface of the skin and a clear yellowish fluid (lymph) or pus is released. As the infection spreads, a severe increase in temperature may occur, accompanied by chills. It is also possible that the lymph nodes closest to the site of injury may become enlarged.

Description

Cellulite develops when bacteria gets under the skin. Most often this disease is caused by staphylococci (especially Staphylococcus aureus) and streptococci. This may happen as a result of:

injuries;
surgical intervention;
chronic skin diseases in which its integrity is compromised (such as psoriasis or eczema);
a dog bite or cat scratch;
infectious bone diseases.

Most often inflammation subcutaneous tissue develops in those suffering from:

skin diseases (psoriasis, eczema);
infectious diseases affecting the skin (chicken pox, fungal diseases);
circulatory disorders (varicose veins).

Also at risk for developing this disease are the elderly, people with weakened immune systems and drug addicts.

However, the cause of cellulite development is not always infection. Inflammation can also be autoimmune.

Cellulitis is not contagious because the inflammation is localized under the skin and the skin provides isolation for the infection.

Diagnostics

The diagnosis of cellulite is made based on clinical picture and results of a general blood test. It is imperative to do a culture of the discharge and an analysis of the sensitivity of pathogenic microflora to antibiotics.

Treatment

Cellulite treatment usually takes place at home, but sometimes hospitalization is required. This disease is treated with antibiotics administered intravenously. If the inflammation is autoimmune, then antibiotics are not required.

Anti-inflammatory drugs are also prescribed. Corticosteroid drugs are often used to relieve inflammation.

In some cases, surgery is required.

Prevention

To prevent cellulite, you need to monitor the condition of your skin - it should always be clean, and you should not allow the skin to peel or crack. However, get carried away antibacterial agents It’s also not allowed for the body, as this can lead to a violation natural microflora skin and weakening its resistance to infections.

Care must be taken when working with raw fish, poultry or meat.

To prevent cellulite, you need to treat it promptly fungal infections. Wounds on the skin must be washed thoroughly to prevent infection from getting under the skin.

At the first symptoms of inflammation, you should immediately consult a doctor.

Panniculitis is a disease that leads to changes in the fatty subcutaneous tissue. So during the inflammatory process fat cells are destroyed, and are replaced connective tissue with the formation of nodes or plaques.

Clinical picture

There are several forms of panniculitis: subacute, acute and recurrent.

subacute form suggests the presence mild symptoms. As a result, when proper treatment the effect will be good;
the most light form– recurrent or chronic panniculitis. In this case, the course of the disease cannot be called severe, and remissions between attacks are quite long;
at acute form the prognosis cannot be called favorable. Often the patient has problems with the liver and kidneys. Relapses follow constantly.

Symptoms directly depend on the form of the disease.

Infiltrative form

IN in this case Externally, the lesion resembles an abscess. However, when the nodes are opened, there is no pus, but fluid is released yellow color oily consistency. If the node is opened, an ulceration may form that does not heal for a long time.

Nodal form

In this case, nodes arise whose size reaches 50 mm. They are not prone to fusion. The skin over the nodes is burgundy.

Plaque form

In the presented case, the nodes grow together. The disease can affect large areas - the entire lower leg, shoulder or thigh. Swelling may occur. Over time, lymphostasis develops.

Visceral form

A distinctive feature is damage to fatty tissue in internal organs. Nephritis, pancreatitis, or hepatitis may develop.

Primary form

Nodes appear that can be located at different depths. Most often they are found on the arms or legs. After the destruction of the node, so-called skin retractions occur - atrophy of adipose tissue. Flu-like symptoms may occur - headache, weakness, etc.

Why does he appear?

Panniculitis occurs spontaneously. It mainly develops in women who are in reproductive age, the nature of the disease is idiopathic.

There is no clear answer to the question of how panniculitis develops. Doctors stop at the fact that the basis of the disease is a change metabolic processes passing through adipose tissues. In some patients, inflammation develops due to that you have one of the following diseases:

lupus erythematosus;
staphylococcus;
sarcoidosis, etc.

Carrying out diagnostics

Panniculitis resembles a disease such as deep vein thrombosis of the legs. That is why a doctor will help you determine what disease you are facing. The bacteria that cause panniculitis are difficult to identify through skin biopsy and culture.

But if you analyze the pus, this will give a good chance to determine the pathogen.

What diagnostic methods are used?

bacteriological culture;
survey;
visual inspection.

How to cure panniculitis?

You can relieve swelling of the affected area by applying moist, cool bandages to the affected area. Also, if possible, the affected part of the body should be elevated.

If the cause of the disease is staphylococcus, the following is usually prescribed:

cephalexin;
intravenous oxacillin;
amoxicillin;
Cefazolin.

If there is a relapse of subcutaneous tissue panniculitis, predisposing skin diseases will have to be treated.

This could be tinea pedis, which can be treated with penicillin injections.

The disease caused by streptococci is treated with drugs that belong to the penicillin group, namely:

amoxicillin;
oxacillin;
phenoxymethylpenicillin.

It is worth noting that during treatment the course of the disease may worsen. This happens because the bacteria die and the enzymes they produce damage the tissue. A couple of weeks after taking antibiotics, the symptoms of the disease subside or disappear altogether.

Traditional methods of treatment

Is she capable ethnoscience help in curing panniculitis?

It will be useful to use:

compresses from plantain leaves;
compresses made from raw beets;
compresses made from hawthorn fruits.

You can also help the body cope with the disease if you drink herbal teas based on eleutherococcus, echinacea or rose hips.

Skin diseases and their prevention (video)

Which doctor should I contact and when?

Who can make the correct diagnosis?

mycologist;
surgeon;
dermatologist;
dermatovenerologist.

Prevention of panniculitis

Since the mechanism of development of the disease is still not clear, prevention as such does not exist. It can only be prevented reappearance illness, for this you will have to persistently treat the ailment that arose first.

So, panniculitis is a disease characterized by the destruction of fatty tissue.

The methods of its treatment and the prognosis for recovery depend on the form of the disease.

Panniculitis is a progressive inflammation of the subcutaneous fatty tissue, which leads to the destruction of fat cells, their replacement with connective tissue with the formation of plaques, infiltrates and nodes. In the visceral form of the disease, damage occurs to the fat cells of the pancreas, liver, kidneys, fatty tissue of the retroperitoneal region or omentum.

Approximately 50% of cases of panniculitis occur in the idiopathic form of the disease, which is more common in women between 20 and 50 years of age. The remaining 50% are cases of secondary panniculitis, which develops against the background of skin and systemic diseases, immunological disorders, the effects of various provoking factors (some medications, cold). The development of panniculitis is based on a violation of lipid peroxidation.

Causes

Panniculitis can be caused by various bacteria (usually streptococci, staphylococci).

Panniculitis in most cases develops on the legs. The disease can occur after injury, fungal infection, dermatitis, ulcer formation. The most vulnerable areas of the skin are those with excess fluid (for example, swelling). Panniculitis can occur in the area of postoperative scars.

Symptoms of panniculitis

The main symptom of spontaneous panniculitis is nodular formations that are located in the subcutaneous fat at different depths. They usually appear on the arms, legs, and less often on the face, chest, and abdomen. After the nodes resolve, areas of fatty tissue atrophy remain, looking like round areas of skin retraction.

The nodular variant is characterized by the appearance of typical nodes ranging in size from 3 mm to 5 cm in the subcutaneous tissue. Skin above the nodes can have a color ranging from normal to bright pink.

The plaque version of panniculitis is characterized by the appearance of separate clusters of nodes that grow together and form bumpy conglomerates. The skin over such formations may be pink, burgundy or burgundy-bluish. In some cases, clusters of nodes spread to the entire tissue of the thigh, leg or shoulder, compressing nerve and vascular bundles. This causes severe pain, swelling of the limb, and the development of lymphostasis.

The infiltrative variant of the disease occurs with the melting of nodes and their conglomerates. The skin in the area of the plaque or node is burgundy or bright red. Next, a fluctuation appears, characteristic of phlegmons and abscesses, but when the nodes are opened, it is not pus that is released, but an oily yellow mass. A long-term non-healing ulcer remains at the site of the opened node.

The mixed version of panniculitis is a transition from a nodular form to a plaque form, and then to an infiltrative one. This option is rare.

At the onset of the disease, headaches, fever, general weakness, pain in muscles and joints, nausea.

The visceral form of the disease is characterized by systemic damage to fatty tissue throughout the body with the development of nephritis, hepatitis, pancreatitis, and the formation of characteristic nodes in the omentum and retroperitoneal tissue.

Panniculitis can last from 2-3 weeks to several years.

Diagnostics

Diagnosis of panniculitis includes examination by a dermatologist together with a nephrologist, gastroenterologist, and rheumatologist.

Blood and urine tests, pancreatic enzyme tests, liver tests, and the Rehberg test are used.

Identification of nodes in visceral panniculitis is carried out using ultrasound examination organs abdominal cavity and kidneys.

Blood culture for sterility helps to exclude the septic nature of the disease.

An accurate diagnosis is established based on the results of a biopsy of the node with histological examination.

Classification

There are spontaneous, primary and secondary forms.

Secondary panniculitis includes:

Immunological panniculitis - often occurs against the background of systemic vasculitis;

Lupus panniculitis (lupus panniculitis) - with a deep form of systemic lupus erythematosus;

Enzymatic panniculitis - associated with the effects of pancreatic enzymes in pancreatitis;

Proliferative cell panniculitis - with leukemia, histiocytosis, lymphoma, etc.

Cold panniculitis is a local form that develops in response to cold exposure;

Steroid panniculitis - occurs in children after completion of corticosteroid treatment;

Artificial panniculitis - associated with the administration of medications;

Crystalline panniculitis - develops with gout, renal failure as a result of deposition of urates, calcifications in the subcutaneous tissue, as well as after injections of pentazocine, meneridine;

Panniculitis associated with α1-antitrypsin deficiency (hereditary disease).

Based on the shape of the nodes formed during panniculitis, infiltrative, plaque and nodular variants of the disease are distinguished.

Patient Actions

At the first symptoms of panniculitis, you should consult a doctor. In addition, you should seek medical help if new symptoms (persistent fever, increased fatigue, drowsiness, blistering, increased redness).

Treatment panniculitis

Treatment of panniculitis depends on its form and course.

With nodular panniculitis with chronic course non-steroidal anti-inflammatory drugs (diclofenac sodium, ibuprofen, etc.), antioxidants (vitamins C, E) are used, and nodular formations are injected with glucocorticoids. Physiotherapeutic procedures are also effective: ultrasound, hydrocortisone phonophoresis, laser therapy, UHF, magnetic therapy, ozokerite.

With infiltrative and plaque forms, subacute course For panniculitis, glucocorticosteroids (prednisolone, hydrocortisone) and cytostatics (methotrexate) are used.

Treatment of secondary forms of the disease includes therapy background disease: systemic lupus erythematosus, pancreatitis, gout, vasculitis.

Complications

Abscess;

Phlegmon;

Gangrene and skin necrosis;

Bacteremia, sepsis;

Lymphangitis;

Meningitis (if the facial area is affected).

Prevention panniculitis

Prevention of panniculitis involves timely diagnosis and treatment primary diseases- fungal and bacterial infection, vitamin E deficiency.

Panniculitis is an inflammation of the subcutaneous fatty tissue. This disease progresses very quickly and causes the destruction of fat cells, which are replaced by connective tissue. As a result adipose tissue replaced by infiltrates, nodes and plaques. In the internal form of the disease, fat cells of internal organs are affected: kidneys, liver, intestines and omentum.

This disease happens primary and secondary. It is noteworthy that the primary form of the disease is detected mainly in women in age group from 20 to 40 years. All patients certainly have excess weight. The secondary form of the disease develops against the background of various diseases and various negative factors.

This article will talk about the main causes of the disease, types of pathology, their diagnosis and treatment.

Despite all the achievements modern medicine, scientists have still not been able to establish exactly how this disease develops. What is known for certain is that the disease can be caused by certain bacteria. Most often these are staphylococci and streptococci. Bacteria penetrate into the subcutaneous tissue through wounds on the skin.

Doctors also noted that panniculitis appears more often on lower limbs than on other parts of the body.

This pathology can develop the following reasons:

Often panniculitis appears on the site of scars from previous operations.

Classification of the disease

We have already talked above that panniculitis can be primary or idiopathic, as well as secondary.

Secondary panniculitis has the following varieties:

Kholodova. It is characterized by single lesions that arise at the site of tissue hypothermia. This type of panniculitis looks like dense nodes Pink colour. As a rule, after 2-2.5 weeks the nodes completely disappear.
Lupus panniculitis. This form of the disease occurs as a complication of systemic lupus erythematosus.
Steroid. This type of disease occurs in children after they take corticosteroids orally for any reason. Doctors do not consider steroid panniculitis as independent disease. The fact is that after finishing taking the above medicines Symptoms of the disease go away on their own within just a couple of weeks.
Artificial panniculitis. It develops in adult patients as the body's response to certain medications.
Enzymatic. Occurs in diseases of the organs digestive system. In particular, this type of panniculitis is most often detected in patients with pancreatitis.
Immunological. In adults, it most often manifests itself in systemic vasculitis. In children it may appear with erythema nodosum.
Proliferative cellular. Such panniculitis is always a consequence of cancer.
Eosinophilic panniculitis occurs with skin diseases.
Crystal. The reason for the appearance of this type of pathology is the deposition of salts in tissues in diseases such as gout and kidney failure.
Panniculitis due to α-protease inhibitor deficiency. It manifests itself in hepatitis, pancreatitis, nephritis and other diseases.

Different forms of the disease lead to various changes in fiber, which often replace one another. According to the form of these changes Panniculitis is divided into:

Special mention should be made of mesenteric panniculitis. It is a nonspecific inflammatory process affecting the mesenteries small intestine. The reasons for the development of this form of pathology are still unknown.

For mesenteric panniculitis There is a change in the cells of the mesentery of the small intestine with thickening of the fatty lobulation. This causes the mesentery to lose its inherent strength.

If idiopathic panniculitis is most often found in women, then the mesenteric form of secondary panniculitis usually found in men. Moreover, the manifestations of the disease cannot be called specific, which significantly complicates diagnosis. With the mesenteric form of panniculitis, the patient experiences abdominal pain varying intensity, nausea and general malaise.

On computed tomography mesenteric panniculitis appears as a dense fatty mass with areas of fibrosis. Treatment of this form of the disease is prescribed after a mandatory biopsy to exclude malignant neoplasms.

According to the nature of inflammation of fatty tissue the disease may be:

Spicy.
Sub-adjust.
Chronic.

For staging accurate diagnosis The patient is examined by a nephrologist, gastroenterologist, and rheumatologist.

Such methods are required research like:

If mesenteric panniculitis is suspected, an ultrasound of the internal organs is prescribed to identify nodes.

Doctors diagnosing panniculitis They try not only to determine the form of the disease, but also to identify the diseases against which it developed. This allows you to quickly create an effective treatment plan.

Treatment of panniculitis

With this disease, only complex therapy. The tactics of using drugs is always determined by the form of the disease and the nature of its course.

Regardless of the form of panniculitis, patients The following groups of drugs are prescribed:

Antihistamines.
Vitamin complexes.
Antibacterial drugs.
Non-steroidal anti-inflammatory drugs.
Hepatoprotectors.

In acute panniculitis Prednisolone and other corticosteroids are prescribed. At severe course diseases, cytostatics Methotrexate and Prospidin are added to them.

With secondary panniculitis, doctors must treat the disease that became the root cause of the disease.

As local treatment for knots and plaques, dressings with Ichthyol and Dubinol are used.

Speed up the treatment process can be done using the following procedures:

Phonophoresis.
Magnetotherapy
Laser therapy.

It should be remembered that panniculitis refers to serious illnesses Therefore, self-medication is prohibited. This can lead to such fatal dangerous complications, such as abscess, phlegmon, gangrene, sepsis, meningitis.