Dermatology pp 861-880 | Cite as

Diseases of the Subcutaneous Fat

  • Otto Braun-Falco
  • Gerd Plewig
  • Helmut H. Wolff
  • Walter H. C. Burgdorf

Abstract

The subcutaneous fat serves as a source of insulation, padding or protection and as an energy storage center. The thickness of the fat varies greatly from person to person and from gegion to fegion. No fat is found on the eyelids and male genitalia, but elsewhere metabolic, hormonal and genetic factors interact to determine the amount of fat accumulated. The fat lies between the dermis and the fascia of the muscles, tendons and ligaments. It is divided by fibrous septa, bands of connective tissue that connect the dermis to the fascia (Fig. 21.1). The true functional unit of fat is the microlobule, a small collection of fat cells serviced by a single vessel; the microlobule has no distinct, easily discerned boundaries, but the larger lobule is encased by fibrous septa. The septa carry the vessels, arteries, veins and lymphatics to the fat and also serve as pathways to the dermis and epidermis.

Keywords

Corticosteroid Lipase Pancreatitis Flare Ghost 

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Bibliography

Panniculitis

  1. Patterson JW (1991) Differential diagnosis of panniculitis. Adv Dermatol 6:309–329; discussion 330PubMedGoogle Scholar
  2. Peters MS, Su WP (1992) Panniculitis. Dermatol Clin 10: 37–57Google Scholar
  3. White WL, Wieselthier JS, Hitchcock MG (1996) Panniculitis: recent developments and observations. Semin Cutan Med Surg 15:278 – 299PubMedCrossRefGoogle Scholar

Erythema Nodosum

  1. Bäfverstedt BO (1954) Erythema nodosum migrans. Acta Derm Venereol (Stockh) 48:381 – 384Google Scholar
  2. Cribier B, Caille A, Heid E et al. (1998) Erythema nodosum and associated diseases. A study of 129 cases. Int J Dermatol 37:667–672PubMedCrossRefGoogle Scholar
  3. Vilanova X, Pinol Aguadè J (1959) Subacute nodular migratory panniculitis. Br J DermatolGoogle Scholar
  4. Waltz KM, Long D, Marks JG Jr et al. (1999) Sweet’s syndrome and erythema nodosum: the simultaneous occurrence of 2 reactive dermatoses. Arch Dermatol 135: 62–66PubMedCrossRefGoogle Scholar

Nodular Vasculitis

  1. Cho KH, Kim YG, Yang SG et al. (1997) Inflammatory nodules of the lower legs: a clinical and histological analysis of 134 cases in Korea. J Dermatol 24:522–529PubMedGoogle Scholar
  2. Montgomery H, O’Leary PA, Barker NW (1945) Nodular vascular disease of the legs. JAMA 128:335–341CrossRefGoogle Scholar
  3. Naschitz JE, Boss JH, Misselevich I et al. (1996) The fasciitis-panniculitis syndromes. Clinical and pathologic features. Medicine (Baltimore) 75:6 – 16CrossRefGoogle Scholar
  4. Schneider JW, Jordaan HF (1997) The histopathologic spectrum of erythema induratum of Bazin. Am J Dermato-pathol 19:323–333CrossRefGoogle Scholar
  5. Yus ES, Simon P (1999) About the histopathology of erythema induratum-nodular vasculitis. Am J Dermatopathol 21: 301–306PubMedCrossRefGoogle Scholar

Lupus Erythematosus Profundus

  1. Hebra F, Kaposi M (1875) On disease of the skin, including exanthemata. New Sydenham Society, LondonGoogle Scholar
  2. Holland NW, McKnight K, Challa VR et al. (1995) Lupus panniculitis (profundus) involving the breast: report of 2 cases and review of the literature. J Rheumatol 22:344–346PubMedGoogle Scholar
  3. Irgang S (1954) Apropos du lupus erythemateux profond. Ann Dermatol Syph 81:246 – 249Google Scholar
  4. Kundig TM, Trueb RM, Krasovec M (1997) Lupus profundus/panniculitis. Dermatology 195:99 – 101PubMedCrossRefGoogle Scholar
  5. Martens PB, Moder KG, Ahmed I (1999) Lupus panniculitis: clinical perspectives from a case series. J Rheumatol 26: 68–72PubMedGoogle Scholar

Infectious Panniculitis

  1. Aleman CT, Wallace ML, Blaylock WK et al. (1999) Subcutaneous nodules caused by Pseudomonas aeruginosa without sepsis. Cutis 63:161 – 163PubMedGoogle Scholar
  2. Callahan TE, Schecter WP, Horn JK (1998) Necrotizing soft tissue infection masquerading as cutaneous abcess following illicit drug injection. Arch Surg 133:812–817; discussion 817–819PubMedCrossRefGoogle Scholar
  3. De Argila D, Rodriguez-Peralto JL, Ortiz-Frutos J (1996) Septal panniculitis associated with infectious mononucleosis. Dermatology 192:291PubMedCrossRefGoogle Scholar
  4. Patterson JW, Brown PC, Broecker AH (1989) Infection-induced panniculitis. J Cutan Pathol 16:183 – 193PubMedCrossRefGoogle Scholar

Cold Panniculitis

  1. Aroni K, Aivaliotis M, Tsele E et al. (1998) An unusual panniculitis appearing in the winter with good response to tetracycline. J Dermatol 25:677 – 681PubMedGoogle Scholar
  2. Ben-Amitai D, Metzker A (1996) Cold panniculitis in a neonate. J Am Acad Dermatol 35:651 – 652PubMedCrossRefGoogle Scholar
  3. Ter Poorten JC, Hebert AA, Ilkiw R (1995) Cold panniculitis in a neonate. J Am Acad Dermatol 33:383 – 385PubMedCrossRefGoogle Scholar

Traumatic Panniculitis

  1. De Groot AC (1994) Is lipoatrophia semicircularis induced by pressure? Br J Dermatol 131:887 – 890PubMedCrossRefGoogle Scholar
  2. Nagore E, Sanchez-Motilla JM, Rodriguez-Serna M et al. (1998) Lipoatrophia semicircularis — a traumatic panniculitis: report of seven cases and review of the literature. J Am Acad Dermatol 39:879 – 881PubMedCrossRefGoogle Scholar
  3. Winkelmann RK, Barker SM (1985) Factitial traumatic panniculitis. J Am Acad Dermatol 13:988 – 994PubMedCrossRefGoogle Scholar

Postinjection Panniculitis and Factitial Panniculitis

  1. Drago F, Rongioletti F, Battifoglio ML et al. (1996) Localised lipoatrophy after acupuncture. Lancet 347:1484PubMedCrossRefGoogle Scholar
  2. Lee JS, Ahn SK, Lee SH (1995) Factitial panniculitis induced by cupping and acupuncture. Cutis 55:217 – 218PubMedGoogle Scholar

Pancreatic Panniculitis

  1. Bern J, Bradley EL III (1998) Subcutaneous manifestations of severe acute pancreatitis. Pancreas 16:551–555CrossRefGoogle Scholar
  2. Dahl PR, Su WP, Cullimore KC, Dicken CH (1995) Pancreatic panniculitis. J Am Acad Dermatol 33:413 – 417PubMedCrossRefGoogle Scholar
  3. Durden FM, Variyam E, Chren MM (1996) Fat necrosis with features of erythema nodosum in a patient with metastatic pancreatic carcinoma. Int J Dermatol 35:39 – 41PubMedCrossRefGoogle Scholar

α1-Antitrypsin Deficiency

  1. Edmonds BK, Hodge JA, Rietschel RL (1991) Alpha 1-antitrypsin deficiency-associated panniculitis: case report and review of the literature. Pediatr Dermatol 8:296 – 299PubMedCrossRefGoogle Scholar
  2. Eriksson S (1996) A 30-year perspective on alpha i-anti-trypsin deficiency. Chest 110:237S — 242SPubMedCrossRefGoogle Scholar
  3. Linares-Barrios M, Conejo-Mir IS, Artola Igarza JL et al. (1998) Panniculitis due to alpha 1-antitrypsin deficiency induced by cryosurgery. Br J Dermatol 138: 552–553PubMedCrossRefGoogle Scholar
  4. Warter J, Storck D, Grosshans E et al. (1972) Syndrome de Weber-Christiane associé à un déficit en alpha 1-anti-trypsine: Enquète familiale. Ann Med Interne (Paris) 123:877–882Google Scholar

Neonatal Fat Necrosis

  1. Balazs M (1987) Subcutaneous fat necrosis of the newborn with emphasis on ultrastructural studies. Int J Dermatol 26:227–230PubMedCrossRefGoogle Scholar
  2. Hernandez-Martin A, de Unamuno P, Fernandez-Lopez E (1998) Congenital ulcerated subcutaneous fat necrosis of the newborn. Dermatology 197:261 – 263PubMedCrossRefGoogle Scholar
  3. Liu FT, Dobry MM, Shames BS et al. (1993) Subcutaneous nodules and hypercalcemia in an infant. Subcutaneous fat necrosis of the newborn. Arch Dermatol 129: 898–902PubMedCrossRefGoogle Scholar
  4. Mather MK, Sperling LC, Sau P (1997) Subcutaneous fat necrosis of the newborn. Int J Dermatol 36:450 – 452PubMedCrossRefGoogle Scholar

Sclerema Neonatorum

  1. de Silva U, Parish LC (1994) Historical approach to scleroderma. Clin Dermatol 12:201 – 205PubMedCrossRefGoogle Scholar
  2. Jardine D, Atherton DJ, Trompeter RS (1990) Sclerema neonatorum and subcutaneous fat necrosis of the newborn in the same infant. Eur J Pediatr 150:125 – 126PubMedCrossRefGoogle Scholar

Cytophagic Histiocytic Panniculitis

  1. Craig AJ, Cualing H, Thomas G et al. (1998) Cytophagic histiocytic panniculitis — a syndrome associated with benign and malignant panniculitis: case comparison and review of the literature. J Am Acad Dermatol 39: 721–736PubMedCrossRefGoogle Scholar
  2. Okamura T, Niho Y (1999) Cytophagic histiocytic panniculitis — what is the best therapy? Intern Med 38:224 – 225PubMedCrossRefGoogle Scholar
  3. Ostrov BE, Athreya BH, Eichenfield AH et al. (1996) Successful treatment of severe cytophagic histiocytic panniculitis with cyclosporine. Semin Arthritis Rheum 25:4. 04–413PubMedCrossRefGoogle Scholar
  4. Winkelmann RK, Bowie EJ (1980) Hemorrhagic diathesis associated with benign histiocytic, cytophagic panniculitis and systemic histiocytosisArch Intern Med 140: 1460–1463PubMedCrossRefGoogle Scholar

Lipodermatosclerosis

  1. Herouy Y, May AE, Pornschlegel G et al. (1998) Lipodermatosclerosis is characterized by elevated expression and activation of matrix metalloproteinases: implications for venous ulcer formation. J Invest Dermatol 111: 822–827PubMedCrossRefGoogle Scholar
  2. Sheth R, Poonevala V (1997) Lipodermatosclerosis: a post-phlebitic syndrome. Int J Dermatol 36:931 – 932PubMedCrossRefGoogle Scholar
  3. Vowden K (1998) Lipodermatosclerosis and atrophie blanche. J Wound Care 7:441 – 443PubMedGoogle Scholar

Medication-Induced Panniculitis

  1. McCauliffe DP, Poitras K (1991) Aspartame-induced lobular panniculitis. J Am Acad Dermatol 24:298 – 300PubMedCrossRefGoogle Scholar

Weber-Christian Syndrome

  1. Christian HA (1928) Relapsing febrile nodular nonsuppurative panniculitis. Arch Intern Med 42:338–351CrossRefGoogle Scholar
  2. Pfeiffer V (1892) Über einen Fall von herdweiser Atrophie des subcutanen Fettgewebes. Dtsch Arch Klin Med 50: 438–449Google Scholar
  3. Weber FP (1925) A case of relapsing nonsuppurative nodular panniculitis, showing phagocytosis of subcutaneous fat cells by macrophages. Brit J Dermatol S 37:301–311CrossRefGoogle Scholar
  4. White JW Jr, Winkelmann RK (1998) Weber-Christian panniculitis: a review of 30 cases with this diagnosis. J Am Acad Dermatol 39:56 – 62PubMedCrossRefGoogle Scholar

Rothmann-Makai Syndrome

  1. Chan HL (1975) Panniculitis (Rothmann-Makai), with good response to tetracycline. Br J Dermatol 92:351–354PubMedCrossRefGoogle Scholar
  2. Makai E (1928) Über Lipogranulomatosis subcutanea. Klin Wochenschr 7:2343 – 2346CrossRefGoogle Scholar
  3. Rothmann M (1894) Über Entzündung und Atrophie des subcutanen Fettgewebes. Virchows Arch Pathol Anat 136:159 – 169Google Scholar

Insulin Lipoatrophy

  1. Asherov J, Mimouni M, Laron Z (1979) Successful treatment of insulin lipoatrophy. A case report. Diabete Metab 5: 1–3PubMedGoogle Scholar
  2. Murao S, Hirata K, Ishida T, Takahara J (1998) Lipoatrophy induced by recombinant human insulin injection. Intern Med 37:1031–1033PubMedCrossRefGoogle Scholar

Involutional Lipoatrophy

  1. Dahl PR, Zalla MJ, Winkelmann RK (1996) Localized involutional lipoatrophy: a clinicopathologic study of 16 patients. J Am Acad Dermatol 35:523 – 528PubMedCrossRefGoogle Scholar
  2. Peters MS, Winkelmann RK (1986) The histopathology of localized lipoatrophy. Br J Dermatol 114:27–36PubMedCrossRefGoogle Scholar

Annular Lipoatrophy and Semicircular Lipoatrophy

  1. Ferreira-Marques J (1953) Lipoatrophia anularis. Ein Fall einer bisher nicht beschriebenen Krankheit der Haut (des Pannikulus adiposus). Arch Dermatol Syph 195: 479–491PubMedCrossRefGoogle Scholar
  2. Gschwandtner WR, Münzberger H (1974) Lipoatrophia semicircularis. Hautarzt 25:222 – 227PubMedGoogle Scholar
  3. Shelley WB, Izumi AK (1970) Annular atrophy of the ankles: a case of partial lipodystrophy. Arch Dermatol 102: 326–329PubMedCrossRefGoogle Scholar

Lipodystrophia Centrifugalis Abdominalis Infantilis

  1. Imamura S, Yamada M, Ikeda T (1971) Lipodystrophia centrifugalis abdominalis infantilis. Arch Dermatol 104: 291–298PubMedCrossRefGoogle Scholar

Local Inflammatory Lipoatrophy

  1. Billings JK, Milgraum SS, Gupta AK et al. (1987) Lipo-atrophic panniculitis: a possible autoimmune inflammatory disease of fat. Report of three cases. Arch Dermatol 123:1662–1666PubMedCrossRefGoogle Scholar
  2. Peters MS, Winkelmann RK (1980) Localized lipoatrophy (atrophic connective tissue disease panniculitis). Arch Dermatol 116:1363 – 1368PubMedCrossRefGoogle Scholar

Partial and Generalized Lipoatrophy

  1. Barraquer R (1906) Histoire clinique d’un cas d’atrophie du tissue cellulo-adipeux. BarcelonaGoogle Scholar
  2. Berardinelli W (1954) An undiagnosed endocrinometabolic syndrome: report of 2 cases. J Clin Endocr Metab 14: 193–204PubMedCrossRefGoogle Scholar
  3. Cronin CC, Higgins T, Molloy M (1995) Lupus, C3 nephritic factor and partial lipodystrophy. Q J Med 88:298 – 299Google Scholar
  4. Dunnigan MG, Cochrane MA, Kelly A et al. (1974) Familial lipoatrophic diabetes with dominant transmission. A new syndrome. Q J Med 43:33 – 48PubMedGoogle Scholar
  5. Gedde-Dahl T Jr, Trygstad O, Van Maldergem L et al. (1996) Genetics of the Berardinelli-Seip syndrome (congenital generalized lipodystrophy) in Norway: epidemiology and gene mapping. Berardinelli-Seip Study Group. Acta Paediatr [Suppl] 413:52 – 58Google Scholar
  6. Griebel M, Mallory SB (1988) Generalized weight loss in a child. Arch Dermatol 124:571 – 576CrossRefGoogle Scholar
  7. Holländer E (1910) Über einen Fall von fortschreitendem Schwund des Fettgewebes und seinem kosmetischen Ersatz durch Menschenfett. Münch Med Wochenschr 57: 1794–1795Google Scholar
  8. Köbberling J, Willms B, Kattermann R et al. (1975) Lipodystrophy of the extremities. A dominantly inherited syndrome associated with lipatrophic diabetes. Humangenetik 29:111 – 120PubMedCrossRefGoogle Scholar
  9. Lawrence RD (1946) Lipodystrophy and hepatomegaly with diabetes, lipaemia, and other metabolic disturbances. A case throwing new light on the action of insulin. Lancet 1:724–731,773–775PubMedCrossRefGoogle Scholar
  10. Mamalaki E, Katsantonis J, Papavasiliou S et al. (1995) A case of partial face-sparing lipodystrophy combining features of generalized lipodystrophy. J Am Acad Dermatol 32: 130 – 133PubMedCrossRefGoogle Scholar
  11. Seip M (1959) Lipodystrophy and gigantismus with associated endocrine manifestations: a new diencephalic syndrom? Acta Paediatr 48:555 – 574PubMedGoogle Scholar
  12. Seip M, Trygstad O (1996) Generalized lipodystrophy, congenital and acquired (lipoatrophy). Acta Paediatr [Suppl] 413:2–28CrossRefGoogle Scholar
  13. Senior B, Gellis SS (1964) The syndromes of total lipodystrophy and of partial lipodystrophy. Pediatrics 33: 593–612PubMedGoogle Scholar
  14. Simons A (1911) Eine seltene Trophoneurose („Lipodystrophia progressiva”). Z Neurol 5:29 – 38Google Scholar

Lipedema

  1. Bilancini S, Lucchi M, Tucci S et al. (1995) Functional lymphatic alterations in patients suffering from lipedema. Angiology 46:333–339PubMedCrossRefGoogle Scholar
  2. Dimakakos PB, Stefanopoulos T, Antoniades P et al. (1997) MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. Int Surg 82:411 – 416PubMedGoogle Scholar
  3. Rudkin GH, Miller TA (1994) Lipedema: a clinical entity distinct from lymphedema. Plast Reconstr Surg 94: 841 – 847; discussion 848 – 849PubMedCrossRefGoogle Scholar

Cellulite

  1. Draelos ZD, Marenus KD (1997) Cellulite. Etiology and purported treatment. Dermatol Surg 23:1177 – 1181PubMedCrossRefGoogle Scholar
  2. Kligman AM (1997) Cellulite: facts and fiction. J Geriatr Dermatol 5:136 – 139Google Scholar
  3. Piérard GE, Nizet JL, Piérard-Franchimont C (2000) Cellulite. From standing fat herniation to hypodermal stretch marks. J Am Dermatopath 22:34 – 37CrossRefGoogle Scholar
  4. Rosenbaum M, Prieto V, Hellmer J et al. (1998) An exploratory investigation of the morphology and biochemistry of cellulite. Plast Reconstr Surg 101:1934–1939PubMedCrossRefGoogle Scholar
  5. Scherwitz C, Braun Falco O (1978) So called cellulite. J Dermatol Surg Oncol 4:230 – 234PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • Otto Braun-Falco
    • 1
  • Gerd Plewig
    • 1
  • Helmut H. Wolff
    • 2
  • Walter H. C. Burgdorf
    • 1
  1. 1.Department of Dermatology and AllergologyLudwig Maximilians UniversityMunichGermany
  2. 2.Department of Dermatology and VenerologyUniversity of LübeckLübeckGermany

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