Non-Neoplastic Dermatopathology

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5.8 Cold Panniculitis vs Lupus Panniculitis

Cold Panniculitis

Lupus Panniculitis

Special studies

Colloidal iron stain to demonstrate mucin deposition in dermis. Immunohistochemistry for CD123 to demonstrate plasmacytoid dendritic cells. Neither of these stains, however, are helpful in distinguishing from lupus panniculitis. Therapy is generally supportive and based upon symptomatology with use of nonsteroidal anti-inflammatory medications for pain. Gradual warming of the exposed areas generally aids in resolution of lesions.

Colloidal iron stain to demonstrate mucin deposition in dermis. Immunohistochemistry for CD123 to demonstrate plasmacytoid dendritic cells. Neither of these stains, however, are helpful in distinguishing from cold panniculitis. Administration of antimalarial drugs, such as hydroxychloroquine, is first-line therapy. Short-term systemic corticosteroids may be added. Steroid-sparing immunosuppressive agents, such as methotrexate, azathioprine, or cyclophosphamide, may be added for severe disease or those cases associated with systemic symptoms. Chronic, relapsing course. Patients may have concomitant discoid or systemic lupus erythematosus. May lead to lipoatrophy and calcinosis, which may be severe and cause disfigurement.

Treatment

Prognosis

Generally a self-limiting condition without sequelae.

Figure 5.8.1 Cold panniculitis. Lobular subcutaneous infiltrate (lower right) with superficial and deep perivascular and periadnexal infiltrate within the dermis. Note that there is no hyalinization of the reticular dermis or subcutis. Figure 5.8.2 Cold panniculitis. Lymphocytic infiltrate around vascular plexus and eccrine units in dermis. The infiltrate is generally less dense than in lupus panniculitis. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

SUBCUTIS

5 DISORDERS OF THE