The fasciitis-panniculitis syndrome in circulatory disorders of the limbs

Abstract

Sporadic reports allude to the similarities between the subcutaneous and fascial sclerosis of venous disease and lymphedema with that of eosinophilic fasciitis and the related fasciitis-panniculitis syndrome. The objective of the present study was to compare the clinical and histological features of the subcutaneous induration in patients with impairment of the venous, arterial, and lymphatic circulation (6 patients) with those of patients with the fasciitispanniculitis syndrome of diverse etiologies (12 patients). The semiquantitative analysis of the microscopic changes evinces the equivalent intensity of subcutaneous septal fibrosis, inflammation and mucinosis, lobular panniculitis, fascial fibrosis and inflammation, as well as microscopic phlebitis and phlebosclerosis in both groups of patients. The similarities of the pathological alterations of the subcutaneous layers are indicative of a shared reaction pattern to a variety of insults. In the patients with circulatory disorders, analysis of the clinical circumstances establishes the convergence of synergistically acting factors in the causation of the fasciitis-panniculitis syndrome. The circulatory impediment is insufficient to induce the syndrome, but it apparently acts as a predisposing factor such that it amplifies the inflammatory-cicatrizing response to one ordinary damage or another. Awareness of the multifactorial etiopathogenesis of the fasciitis-panniculitis syndrome in patients with circulatory disturbances ushers in a novel perspective of therapeutic intervention at multiple levels.