PANNICULITIS
subacute nodular migratory panniculitis
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I have been following a 43 year old white woman for 19 months with a 17X10cm
brawny enlarging plaque on the shin.  Clinically the lesion has been most
consistant with subacute nodular migratory panniculitis.  Repeated biopsies 
to the fascial plane have revealed focal fat necrosis with mild acute and 
chronic inflammation.  Laboratory evaluation has revealed normal CBC with 
diff, sed rate, ANA, LFT's, TFT's, UA, ASO, PPD, alpha 1 antitrypsin level.  
She has shown no improvement with Indocin, motrin,and SSKI.  Prednisone 
80mgQD with slow taper had minimal benefit, as did Dapsone at 150mg.  Her 
past medical history is unremarkable and she takes no medicines (she stopped 
BCP 1 year agoon my request) Any ideas on other diagnoses or treatments.    

Brad Becker M.D.
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Has a factitial process been excluded?  If not, a trial of Unna boot may be 
helpful.

Steve Feldman, MD
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