Brief Answer: Panniculitis is simple & recoverable condition Detailed Answer: Hello Madam, Very good morning to you and thanks for showing confidence in me. I beg your pardon for replying bit late as I was discussing your condition with my XXXXXXX colleagues. After a through discussion with them and sharing their experience in this condition, I am pretty happy to tell you that now you are out of danger of any serious/major condition. I am highly thankful to your vascular surgeon for improvising diagnosis of “Panniculitis” in yourself. Let me first of all reassure you that after the diagnosis of “Panniculitis” you are totally out of danger of any major problem. Now regarding panniculitis- it is a diverse condition where mainly the subcutaneous fat (the fatty tissue under the skin) gets inflamed due to various reasons. It is a very simple and benign condition and never poses any problem in future life. It never turns into any serious problem in majority of patients. As only subcutaneous fat is involved, the prognosis is good. Most cases recover after a few months, and permanent remission is always present. So it is totally different form cellulitis in its causation and prognosis. It do not get spread to larger areas and that is why you have got small scabs rather than spreading of the infection. There are multiple other subtypes of Panniculitis and to reach to the exact type our plan of action should be: 1. To meet a dermatologist and get this diagnosis confirmed. 2. To go for all the routine investigations of blood(complete blood count) with ESR including chest X ray and to rule out any microbial infection. 3. To go for deep biopsy of the affected area so that exact type of panniculitis can be diagnosed. In all the types of panniculitis the main treatment is pain killer tablets and then next line of therapy is by oral and topical steroids. If I were your treating dermatologist then I would have started with a moderate to mild potency steroid cream such as mometasone or fluticasone cream to be applied to time daily in a very thin layer. An oral pain killer would be of great help if taken daily after meals. If in few days the improvement is not seen then would have started with oral steroids. Let me reassure you again that you are in much better situation now. I am quite confident that you will definitely be alright. Let me have the pleasure to invite you to Pink city, Jaipur after getting complete recovery. Rest of my suggestions are as previously as given in earlier XXXXXXX I am always besides you for any of your health problems and you will be totally alright!! My all best wishes to you, With regards, Dr Sanjay Kumar Kanodia MD

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Brief Answer: Prophylactic short course of streroid can be worth Detailed Answer: Hello Madam, Thanks for your follow up. I can understand your part of frustration to not get best and earliest possible help which you must get at this juncture. Even then I reassure you again that if it is physically diagnosed as Panniculitis then there is nothing to worry. Till the time you get a personalized help, I suggest, if you can buy a cream containing medium to low potency steroid such as mometasone or fluticasone cream with an antibiotic such as mupirocin or fucidin. In India it is available as with the name of Flutibact. Otherwise you can search for individual fluticasone cream and another cream containing mupirocin or fucidin. Though we need a high potency steroid but for interim of help it can sere better. If you can request your nurse to give a short course of low dose oral steroid of prednisolone 20 mg for 10 days and then 10 mg for next days and then same 10 mg on alternate days for next days (total 30 days). It is to be taken in the morning after heavy breakfast. If this can be given then would be of great help in deciding about pannicultis, as is the main course of therapy for it. Though in general it is given 1 mg per kilogram but as a prophylactic therapy can be given in the dose suggested by me. There are certain important points of suggestion as described before: 1. Do not pinch, pop or even try to touch any of the area. 2. Kindly avoid scratching any area of normal skin also, as it leads to minor entry points for the entry of bacteria. 3. Wear cotton clothes and cotton undergarments to be changed two times a day. 4. Maintain proper hygiene and take two times daily bath or at-least once. 5. Avoid any kind of stress, even for this condition also as stress is one of the very important factor playing role in our immunity (making it low) so prone for infections. Yoga, meditations and simple walk do help a lot in improving immunity. 6. Do not stand for long time during your day time and take rest along with limb raising so that there should not be edema of feet. I wish you could be here so that I would have taken care of you better. In last few months there is a kind of bond which I feel from inside. Let you enjoy your holidays with best of enthusiasm. I wish and pray for early and best recovery. With regards, Dr Sanjay Kumar Kanodia MD

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