The medical histories of three patients show the association of subcutaneous fat necrosis and polyarthritis in acute pancreatitis. The serum amylase levels were extremely high, reaching a peak two to three days after the appearance of the skin lesion. It is believed that lipase liberated from the pancreas acts on the involved fat tissue, changing the fat to fatty acid and glycerol which, being water-soluble, is carried into the lymphatics while fatty acids combine with calcium to produce insoluble soaps. The soaps make up the opaque plaques characterizing fat necrosis. These enzymatic and chemical reactions explain the fat necrosis and the hypocalcemia frequently seen in patients with acute pancreatitis.
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Arnold B. Swerdlow (1960) studied this question.
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