Royal College of Surgeons in Ireland
Alpha-1 antitrypsin deficiency–associated panniculitis.pdf (1.08 MB)

Alpha-1 antitrypsin deficiency–associated panniculitis

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Version 2 2023-10-10, 14:56
Version 1 2022-08-29, 16:38
journal contribution
posted on 2023-10-10, 14:56 authored by Alessandro N Franciosi, James Ralph, Naoimh J O'Farrell, Colm Buckley, Christian Gulmann, Marina O'Kane, Tomas CarrollTomas Carroll, Noel G McElvaneyNoel G McElvaney

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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Published Citation

Franciosi AN. et al. Alpha-1 antitrypsin deficiency-associated panniculitis. J Am Acad Dermatol. 2021:S0190-9622(21)00232-2.

Publication Date

28 January 2021

PubMed ID



  • Beaumont Hospital
  • Medicine

Research Area

  • Immunity, Infection and Inflammation
  • Respiratory Medicine
  • Population Health and Health Services


Elsevier BV


  • Accepted Version (Postprint)