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The exact cause of this condition is not known, but it involves collagen degeneration and a granulomatous response in the layer of the skin called the dermis, often affecting the deeper fat layer and thickening dermal blood vessels. Diagnosis is confirmed through a skin biopsy showing inflammatory cell infiltrate and necrotising vasculitis.
Coagulative necrosis occurs primarily in tissues such as the kidney, heart and adrenal glands. [6] Severe ischemia most commonly causes necrosis of this form. [8] Liquefactive necrosis (or colliquative necrosis), in contrast to coagulative necrosis, is characterized by the digestion of dead cells to form a viscous liquid mass. [7]
Sebaceous glands, sebaceous ducts, and the infundibulum are all soon engulfed in sebaceous epithelium necrosis. There may be granulomas of foreign bodies. The epidermis may also necrotize. Both extensive corium necrosis and bleeding are major components. Neutrophils typically don't exist or appear later. Finally, fibrosis is visible. [5]
Initial symptoms of Fournier gangrene include swelling or sudden pain in the scrotum, fever, pallor, and generalized weakness. It is characterized by pain that extends beyond the border of the demarcated erythema. [2] Most cases present mildly, but can progress in hours.
Fat necrosis in the breast occurs around 0.6%, this represents 2.75% of lesions that end up being benign. However, 0.8% of fat necrosis occurs from tumors of the breast, 1–9% occurs in breast reduction surgery. Individuals that are high risk include women around the age of 50yrs along with pendulous breasts. [8]
Liquefactive necrosis (or colliquative necrosis) is a type of necrosis which results in a transformation of the tissue into a liquid viscous mass. [1] Often it is associated with focal bacterial or fungal infections, and can also manifest as one of the symptoms of an internal chemical burn . [ 2 ]
Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness. [1] The feet and hands are most commonly affected. [ 1 ] If the gangrene is caused by an infectious agent, it may present with a fever or sepsis .
Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. [1] Early on, there may be no symptoms. [1] Gradually joint pain may develop, which may limit the person's ability to move. [1] Complications may include collapse of the bone or nearby joint surface. [1]