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This 45 year old woman with systemic lupus erythematosus developed painful subcutaneous swelling of her left hidfoot. The lesion eventually healed with resulting marked loss of subcutaneous tissue (figure). Panniculitis is uncommon in lupus. Its frequency is approximately 2-3% and it may develop before, with, or after the onset of discoid or systemic lupus. Frequent sites of involvement include the arms, buttocks, head, neck, and thighs. Typical presentation is of deep subcutaneous nodules or plaques with superimposed epidermal changes of atrophy, ulceration, erythema, or poikiloderma. Histopathology reveals hyaline necrosis of fat and lymphocytic infiltrate around blood vessels and subcutaneous tissues.1 Calcification may be noted in old established lesions. The panniculitis tends to follow a chronic course with recurrences and remissions; resolution is commonly accompanied by large areas of depression and lipoatrophy.2
Contributors: g d wright, r powell, m doherty. City Hospital, Nottingham NG5 1PB, UK.
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