Disseminated panniculitis with subcutaneous abscesses and fat necrosis associated with alpha‐1 antitrypsin deficiency

Schöfl, Susanne; Koch‐Thalhammer, Doris; Jabkowski, Jörg; Sega, Wolfgang; Sepp, Norbert; Geroldinger‐Simic, Marija

doi:10.1111/ddg.14152

Cited by 1 publication

(1 citation statement)

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“…Nevertheless, IV-AAT is costly and requires weekly administration of a purified blood product. Whether long-term IV-AAT is required to maintain remission is unclear, although published evidence 77 supports our experience 52 that patients may relapse quickly when augmentation is stopped. Where long-term IV-AAT is not feasible, clinicians could consider short-term use for remission, with a view to transitioning to oral agents.…”

Section: Discussionsupporting

confidence: 54%

Alpha-1 antitrypsin deficiency–associated panniculitis

Franciosi

Ralph

O’Farrell

et al. 2022

Journal of the American Academy of Dermatology

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Background: Panniculitis represents a rare and potentially lethal manifestation of alpha-1 antitrypsin deficiency (AATD). Evidence regarding management is limited to case reports and small case series. We sought to clarify typical features and investigation of AATD-associated panniculitis and assess the evidence regarding therapeutic options.Search methodology: Articles and abstracts published between 1970 and 2020 were identified by searches of MEDLINE, PubMed, and secondary searches of references from relevant articles using the search terms ''panniculitis,'' ''alpha-1,'' ''antitrypsin,'' ''deficiency,'' and ''Weber-Christian.'' Findings: We identified 117 cases of AATD-associated panniculitis. In 1 series, AATD was present in 15% of all cases of biopsy-proven panniculitis. Failure to achieve clinical response was seen in all instances of systemic steroid use. Dapsone, although effective and accessible, is frequently associated with failure to achieve remission. In these instances, intravenous AAT augmentation therapy generally resulted in response.Conclusions: AATD may be more prevalent among patients presenting with panniculitis than previously thought. Patients presenting with panniculitis and systemic illness show high mortality risk. Although most cases are associated with the severe ZZ-genotype, moderate genotypes may also predispose to panniculitis. Dapsone remains the most cost-effective therapeutic option, whereas intravenous AAT augmentation remains the most efficacious. Finally, glucocorticoids appear ineffective in this setting.

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Section: Discussionsupporting

confidence: 54%