Panniculitis in childhood and adolescence.
BACKGROUND
The purpose of the present paper was to describe the clinical manifestations and treatment of patients with panniculitis.


METHODS
From January 1983 to December 2002, 4294 patients were treated for pediatric rheumatological diseases at Pediatric Rheumatology Unit, University of São Paulo, Brazil. Of these, 35 children and adolescents (0.8%) presented with panniculitis: erythema nodosum (EN) or Weber-Christian disease (WCD). Clinical characteristics, laboratory exams, biopsy of the lesion, treatment and clinical course were studied.


RESULTS
Of the 35 patients, 29 presented with EN and six with WCD, one of these with cytophagic histiocytic panniculitis. Mean age at symptom onset was 85 months (6-204 months) and the mean duration of follow up was 55 months (1-144 months). All the patients presented with inflammatory subcutaneous nodules. The patients with WCD presented with systemic manifestations and cutaneous atrophy. The principal etiologies of EN were streptococcal infection (42%), undetermined (13.5%), pulmonary tuberculosis (10%), and acute rheumatic fever (10%). Biopsy of the nodules indicated septal panniculitis in 14 patients with EN and lobular panniculitis without vasculitis in the patients with WCD, one of which had cytophagic histiocytic panniculitis. There was recurrence in 11 patients (38%) with EN and in all those with WCD. Non-steroidal anti-inflammatory drugs were used in 15 patients with EN and corticosteroids and/or immunosuppressive drugs in the six patients with WCD. Three patients died.


CONCLUSIONS
EN is the most frequent panniculitis, with a benign course and is mainly associated with infections. WCD is a severe disease, with systemic involvement, that proceeds with cutaneous atrophy and requires the use of corticosteroids and or immunosuppressive drugs.
Department of Pediatrics, Pediatric Rheumatology Unit, University of São Paulo, Brazil.
Ana J P
AJ
Moraes
Pollyana M F
PM
Soares
Aura L
AL
Zapata
Ana P N
AP
Lotito
Adriana M E
AM
Sallum
Clovis A A
CA
Silva
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004893:Erythema Nodosum / Q000150:complications / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015434:Panniculitis / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D010201:Panniculitis, Nodular Nonsuppurative / Q000150:complications / Q000188:drug therapy