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Suggestions for a New Clinical Classification Approach to Panniculitis Based on a Mayo Clinic Experience of 207 Cases

  • Original Research Article
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Abstract

Background

Panniculitis, or inflammation of adipose tissue, includes a heterogeneous group of disorders with similar morphologic presentations. Currently, panniculitides are classified based on histopathologic findings only.

Objective

In this retrospective study of 207 cases of biopsy-proven panniculitis over 20 years at Mayo Clinic, we aimed to propose a new classification that integrates the clinical morphologic features with the histopathology of panniculitis.

Methods

We collected patient demographic and lesion morphologic characteristics using lesion photographs and physician notes for each of our 207 cases, including location, ulceration, scale, pattern (unilateral versus circumferential), atrophy/sclerosis (cicatricial), redness, and swelling.

Results

The panniculitides most likely to ulcerate were calciphylaxis (85.7% ulcerating), pancreatic panniculitis (66.6%), and α1-antitrypsin deficiency-associated panniculitis (100%). The panniculitides least likely to ulcerate were erythema nodosum and medication-induced and granulomatous panniculitis. This retrospective study used only descriptions in clinical notes and available medical photographs.

Conclusion

We present an updated classification schema of panniculitides based on clinical findings. The primary distinctions are based on ulceration, location, and number of lesions. Although complete distinction of all panniculitides based on clinical examination alone is not possible, we hope the proposed schema allows clinicians to tailor differential diagnoses.

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Acknowledgments

Marianne Mallia, ELS, MWC, Senior Scientific/Medical Editor, Mayo Clinic, substantively edited the manuscript. The Scientific Publications staff at Mayo Clinic provided proofreading, administrative, and clerical support.

Author information

Authors and Affiliations

  1. Mayo Clinic, Rochester, MN, USA

    Nimay C. Anand & Mika Takaichi

  2. Department of Dermatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Emma F. Johnson, David A. Wetter, Mark D. P. Davis & Afsaneh Alavi

Authors
  1. Nimay C. Anand
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  2. Mika Takaichi
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  3. Emma F. Johnson
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  4. David A. Wetter
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  5. Mark D. P. Davis
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  6. Afsaneh Alavi
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Corresponding author

Correspondence to Afsaneh Alavi.

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Funding

Nimay Anand is funded by the Vanderbilt Medical Scholars Program. No other funding sources were used to assist in the preparation of this article.

Conflicts of interest

Afsaneh Alavi is an investigator for Boehringer Ingelheim and Processa Pharmaceuticals, and a consultant for AbbVie, Boehringer Ingelheim, InflaRx, Novartis, and UCB. Nimay C. Anand, Mika Takaichi, Emma F. Johnson, David A. Wetter, and Mark D.P. Davis have no conflicts of interest to declare.

Availability of data and material

All data generated and/or analyzed during this study are included in this published article (and its supplementary information files).

Code availability

Not applicable.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Mayo Clinic Institutional Review Board (#20-010125).

Consent to participate

The Mayo Clinic Institutional Review Board approved the study and waived written informed consent for those who provided research authorization.

Consent for publication

Not applicable.

Author contributions

Concept and design: EFJ, DAW, AA. Acquisition, analysis, or interpretation of data: NCA, EFJ, AA. Drafting of the manuscript: NCA, AA. Critical revision of the manuscript: All authors.

Supplementary Information

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Supplementary file1 (PDF 237 kb)

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Anand, N.C., Takaichi, M., Johnson, E.F. et al. Suggestions for a New Clinical Classification Approach to Panniculitis Based on a Mayo Clinic Experience of 207 Cases. Am J Clin Dermatol 23, 739–746 (2022). https://doi.org/10.1007/s40257-022-00709-9

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  • DOI: https://doi.org/10.1007/s40257-022-00709-9

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