Skin manifestations of pancreatic diseases

Abstract

Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.

Painful subcutaneous nodules in an alcoholic: a case of pancreatic panniculitis

“…Although the pathogenesis of pancreatic panniculitis is not fully understood, it is hypothesized that the release of high amounts of pancreatic enzymes may lead to a focal necrosis of lipids with an accompanying inflammatory reaction [1]. It has also been suggested that additional factors are necessary for the development of pancreatic panniculitis such as increased vessel permeability as this allows the pancreatic enzymes to enter the circulation and into subcutaneous fat [2]. Treatment of pancreatic panniculitis is mostly supportive and aims to target any underlying pancreatic pathology [1].…”

“…The first case of pancreatic panniculitis was initially described by Chiari in 1883, characterized by necrosis of subcutaneous fat [1][2][3]. This entity continues to be a rare manifestation today, occurring with higher incidence in middle-aged male patients with a history of alcoholism [1].…”

“…Pancreatic panniculitis clinically presents as painful, erythematous, subcutaneous nodules that may ulcerate spontaneously and exude an oily brown substance [2]. Lesions classically present on the distal extremities but may may also appear on the trunk, chest, buttocks, and scalp [4].…”

Extra-pancreatic manifestations reported in association with pancreatitis; an international survey report

“…Other extra pancreatic manifestations that have been described in association with pancreatitis include panniculitis, polyarthritis (PPP) syndrome [ 13 ]. Cutaneous manifestations reported with pancreatitis include acanthosis nigricans, necrolytic migratory erythema, livedo reticularis and hemorrhagic skin lesions seen in severe acute pancreatitis (AP) [ 14 ]. Other symptoms that have been described with AP include fatigue [ 13 ], abdominal wall abscess and epididymoorchitis [ 15 ].…”