Pancreatic panniculitis

A complication of pancreatitis that occurs in 2% of cases.

Skin lesions can be the initial manifestation of pancreatic dysfunction in 45% of cases.

Approximately 60% of patients with skin lesions and pancreatic dysfunction lack significant abdominal symptoms.

Associated with acute or chronic pancreatitis, pancreatic carcinoma, pancreatic pseudocysts, traumatic pancreatitis, therapy for chronic hepatitis C, pancreas divisum and acute fatty liver of pregnancy.

Typical lesions are erythematous to brown subcutaneous nodules that are tender and develop most frequently on the legs, but can appear on the arms, trunk and scalp.

The subcutaneous nodules can ulcerate or express oil and viscous exudate.

Patients may experience abdominal pain, fever, ascites, pleural effusions, abdominal visceral fat necrosis, polyarthritis, and osteolytic bone lesions.

Polyarthritis is attributed to necrosis in periarticular fat tissue.

Schmid triad refers to panniculitis with polyarthritis, pancreatic tumor, and eosinophilia.

Schmid triad associated with a poor prognosis.

Incisional skin biopsy of lesions shows lobular panniculitis with extensive subcutaneous fat necrosis, anucleate necrotic adipocytes, granular basophilic material with dystrophic calcifications, which confirms the diagnosis.

Differential diagnosis of skin lesions includes erythema nodosum, deep fungal infection, atypical mycobacterial infection, subcutaneous metastases, and erythema induratum.

Elevated levels of lipase and amylases suggest pancreas pathology, but levels do not correlate with pancreatic disease, and enzyme levels may be normal.

Treatment requires diagnosis and management of the underlying pancreatic disease process.

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