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Dermatologic Manifestations of Localized Lipodystrophy Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jun 21, 2016
 

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.

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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.

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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.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, 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, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), 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, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

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