eMedicine Specialties > Dermatology > Diseases of the Subcutaneous Tissue

Lipodystrophy, Localized: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Isabelle Thomas, MD, Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange
Contributor Information and Disclosures

Updated: Apr 29, 2008

Differential Diagnoses

Lawrence-Seip Syndrome
Lipodystrophy, HIV
Lipodystrophy, Progressive
Morphea

Other Problems to Be Considered

Generalized lipodystrophies
Partial lipodystrophies
Facial hemiatrophy
Panniculitis
Connective-tissue disorders associated with panniculitis

Workup

Laboratory Studies

  • No associated laboratory abnormalities are present in most cases of localized lipodystrophy.
  • Complete blood counts, chemistry, erythrocyte sedimentation rate, renal function tests, and serum antibody tests should be performed in search of an underlying autoimmune condition in cases associated with panniculitis.
    • A transient microcytic anemia, thrombocytosis, and elevated erythrocyte sedimentation rate have been reported in cases of lipophagic panniculitis.
    • Serum antinuclear antibodies may be positive in cases associated with an autoimmune disorder.

Procedures

  • A skin biopsy of an affected area deep enough to include the subcutaneous tissue should be performed to confirm the diagnosis and to exclude underlying conditions. Direct immunofluorescence testing should be requested.

Histologic Findings

Centrifugal lipodystrophy is characterized by a loss of fat in the depressed area and evidence of panniculitis in the surrounding inflammatory area.

A pattern of involutional lipoatrophy is the common finding in the second subgroup, whether idiopathic or associated with a history of trauma, pressure, or local injections. Individual adipocytes and fat lobules are smaller and fewer, separated by hyaline material, with prominent and numerous capillaries, and minimal or no inflammation is present. No foreign body giant cell or lipophage is present.

Histologic evidence of panniculitis is usually present if a biopsy is performed on lesions early enough in the third subgroup. A combination of lipoatrophy and a predominantly lymphocytic or histiocytic infiltrate made of lipophages is most commonly found. Other features may vary with the underlying cause of panniculitis.

Lipophagic panniculitis is characterized by a panlobular panniculitis with a predominantly histiocytic infiltrate made of foamy and Toutonlike lipophages in the subcutaneous and periappendageal fat, giving it a granulomatous appearance. Immunofluorescence study findings are negative.

In cases of panniculitis associated with connective-tissue disorders, histopathologic findings may be diagnostic of lupus, scleroderma, dermatomyositis, or overlap disease, but they are not always specific. Lupus panniculitis is best defined as a mostly lobular panniculitis with a predominantly lymphocytic infiltrate. Lymphoid follicles with germinal centers around the septa and hyaline fat necrosis, when present, are characteristic. Changes may be confined to the subcutaneous tissue in about one half of cases, or the overlying epidermis and dermis may show evidence of discoid lupus erythematosus, such as epidermal atrophy, hyperkeratosis, hydropic degeneration of the dermoepidermal junction, and perivascular and appendageal lymphocytic infiltration of the overlying skin. Direct immunofluorescence findings are positive in most patients, with linear deposits of immunoglobulin M and C3 along the dermoepidermal junction.

Morphea profunda shows thickening and hyalinization of the septal panniculus and fascia. Small aggregates of lymphocytes and plasma cells as well as eosinophils may be observed and help in differentiating it from lupus.

More on Lipodystrophy, Localized

Overview: Lipodystrophy, Localized
Differential Diagnoses & Workup: Lipodystrophy, Localized
Treatment & Medication: Lipodystrophy, Localized
Follow-up: Lipodystrophy, Localized
References
[ CLOSE WINDOW ]

References

  1. Capanni C, Mattioli E, Columbaro M, Lucarelli E, Parnaik VK, Novelli G, et al. Altered pre-lamin A processing is a common mechanism leading to lipodystrophy. Hum Mol Genet. Jun 1 2005;14(11):1489-502. [Medline].

  2. Monajemi H, Zhang L, Li G, Jeninga EH, Cao H, Maas M, et al. Familial partial lipodystrophy phenotype resulting from a single-base mutation in deoxyribonucleic acid-binding domain of peroxisome proliferator-activated receptor-gamma. J Clin Endocrinol Metab. May 2007;92(5):1606-12. [Medline].

  3. Jeninga EH, van Beekum O, van Dijk AD, Hamers N, Hendriks-Stegeman BI, Bonvin AM, et al. Impaired Peroxisome Proliferator-Activated Receptor {gamma} Function through Mutation of a Conserved Salt Bridge (R425C) in Familial Partial Lipodystrophy. Mol Endocrinol. May 2007;21(5):1049-65. [Medline].

  4. Dahl PR, Zalla MJ, Winkelmann RK. Localized involutional lipoatrophy: a clinicopathologic study of 16 patients. J Am Acad Dermatol. Oct 1996;35(4):523-8. [Medline].

  5. Aviles-Izquierdo JA, Longo-Imedio MI, Hernanz-Hermosa JM, Lazaro-Ochaita P. Bilateral localized lipoatrophy secondary to a single intramuscular corticosteroid injection. Dermatol Online J. Mar 30 2006;12(3):17. [Medline].

  6. Ball NJ, Cowan BJ, Moore GR, Hashimoto SA. Lobular panniculitis at the site of glatiramer acetate injections for the treatment of relapsing-remitting multiple sclerosis. A report of two cases. J Cutan Pathol. Apr 2008;35(4):407-10. [Medline].

  7. Abbas O, Salman S, Kibbi AG, Chedraoui A, Ghosn S. Localized involutional lipoatrophy with epidermal and dermal changes. J Am Acad Dermatol. Mar 2008;58(3):490-3. [Medline].

  8. Imamura S, Yamada M, Ikeda T. Lipodystrophia centrifugalis abdominalis infantilis. Arch Dermatol. Sep 1971;104(3):291-8. [Medline].

  9. Commens C, O'Neill P, Walker G. Dermatomyositis associated with multifocal lipoatrophy. J Am Acad Dermatol. May 1990;22(5 Pt 2):966-9. [Medline].

  10. Ahn S, Yoo M, Lee S, Choi E. A clinical and histopathological study of 22 patients with membranous lipodystrophy. Clin Exp Dermatol. Jul 1996;21(4):269-72. [Medline].

  11. André P. [Post-cortisone lipo-atrophy treated by an autologous graft of adipose cell islets]. Ann Dermatol Venereol. 1990;117(10):733-4. [Medline].

  12. Atlan-Gepner C, Bongrand P, Farnarier C, Xerri L, Choux R, Gauthier JF, et al. Insulin-induced lipoatrophy in type I diabetes. A possible tumor necrosis factor-alpha-mediated dedifferentiation of adipocytes. Diabetes Care. Nov 1996;19(11):1283-5. [Medline].

  13. Capeau J, Magre J, Lascols O, Caron M, Bereziat V, Vigouroux C. [Primary lipodystrophies]. Ann Endocrinol (Paris). Feb 2007;68(1):10-20. [Medline].

  14. Gruber PC, Fuller LC. Lipoatrophy semicircularis induced by trauma. Clin Exp Dermatol. May 2001;26(3):269-71. [Medline].

  15. Hagari Y, Sasaoka R, Nishiura S, Ishihara M, Mihara M, Shimao S. Centrifugal lipodystrophy of the face mimicking progressive lipodystrophy. Br J Dermatol. Oct 1992;127(4):407-10. [Medline].

  16. Handfield-Jones SE, Stephens CJ, Mayou BJ, Black MM. The clinical spectrum of lipoatrophic panniculitis encompasses connective tissue panniculitis. Br J Dermatol. Nov 1993;129(5):619-24. [Medline].

  17. Imamura S, Yamada M, Yamamoto K. Lipodystrophia centrifugalis abdominalis infantilis. A follow-up study. J Am Acad Dermatol. Aug 1984;11(2 Pt 1):203-9. [Medline].

  18. Karkavitsas C, Miller JA, Kirby JD. Semicircular lipoatrophy. Br J Dermatol. Nov 1981;105(5):591-3. [Medline].

  19. Kayikcioglu A, Akyurek M, Erk Y. Semicircular lipoatrophy after intragluteal injection of benzathine penicillin. J Pediatr. Jul 1996;129(1):166-7. [Medline].

  20. Martinez A, Malone M, Hoeger P, Palmer R, Harper JI. Lipoatrophic panniculitis and chromosome 10 abnormality. Br J Dermatol. May 2000;142(5):1034-9. [Medline].

  21. Perrot H. [Localized lipo-atrophies]. Ann Dermatol Venereol. 1988;115(4):523-7. [Medline].

  22. Peters MS, Su WP. Panniculitis. Dermatol Clin. Jan 1992;10(1):37-57. [Medline].

  23. Peters MS, Winkelmann RK. Localized lipoatrophy (atrophic connective tissue disease panniculitis). Arch Dermatol. Dec 1980;116(12):1363-8. [Medline].

  24. Peters MS, Winkelmann RK. The histopathology of localized lipoatrophy. Br J Dermatol. Jan 1986;114(1):27-36. [Medline].

  25. Reeves WG, Allen BR, Tattersall RB. Insulin-induced lipoatrophy: evidence for an immune pathogenesis. Br Med J. Jun 21 1980;280(6230):1500-3. [Medline].

  26. Requena L, Sánchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol. Sep 2001;45(3):325-61; quiz 362-4. [Medline].

  27. Rongioletti F, Rebora A. Annular and semicircular lipoatrophies. Report of three cases and review of the literature. J Am Acad Dermatol. Mar 1989;20(3):433-6. [Medline].

  28. Roth DE, Schikler KN, Callen JP. Annular atrophic connective tissue panniculitis of the ankles. J Am Acad Dermatol. Nov 1989;21(5 Pt 2):1152-6. [Medline].

  29. Shelley WB, Izumi AK. Annular atrophy of the ankles. A case of partial lipodystrophy. Arch Dermatol. Sep 1970;102(3):326-9. [Medline].

  30. Tremeau-Martinage C, Bayle-Lebey P, Grouteau E, Bazex J. Localized lipoatrophia with persistent circulating autoantibodies and partial immunoglobulin A deficiency in a child. Dermatology. 1996;192(4):353-7. [Medline].

  31. Tsuji T, Kosaka K, Terao J. Localized lipodystrophy with panniculitis: light and electron microscopic studies. J Cutan Pathol. Dec 1989;16(6):359-64. [Medline].

  32. Umbert IJ, Winkelmann RK. Adult lipophagic atrophic panniculitis. Br J Dermatol. Mar 1991;124(3):291-5. [Medline].

  33. van Gurp PJ, Tack CJ, van der Valk M, Reiss P, Lenders JW, Sweep FC, et al. Sympathetic nervous system function in HIV-associated adipose redistribution syndrome. AIDS. Mar 21 2006;20(5):773-5. [Medline].

  34. Winkelmann RK, McEvoy MT, Peters MS. Lipophagic panniculitis of childhood. J Am Acad Dermatol. Nov 1989;21(5 Pt 1):971-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

localized lipoatrophy, lipodystrophia centrifugalis abdominalis infantilis, centrifugal lipoatrophy, annular lipoatrophy, semicircular lipoatrophy, lipoatrophia semicircularis, involutional lipoatrophy, lipophagic granulomatous panniculitis, lipoatrophic panniculitis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Isabelle Thomas, MD, Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange
Isabelle Thomas, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Daniel Mark Siegel, MD, MS, Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate
Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.