Dermatologic Manifestations of Generalized Lipodystrophy Treatment & Management
- Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD more...
Successful treatment of acanthosis nigricans (AN) in association with generalized lipodystrophy was accomplished in 1 patient with etretinate beginning at 75 mg/d. Therapy for AN was undertaken in this patient for cosmetic reasons. After 4 weeks, the cutaneous eruption had disappeared, with only modest elevation of the preexisting hyperlipemia.
Substitution of eucaloric medium-chain triglycerides for long-chain fatty acids in the diet of 1 patient led to improvement of chylomicronemia, xanthomatosis, hypertriglyceridemia, hepatomegaly, carbohydrate tolerance, and hyperinsulinemia, but not lipoatrophy. Dietary fish oil also may be useful in improving AN.
Because conventional lipid-lowering and antihyperglycemic medications may be insufficient to control severe metabolic abnormalities, leptin has been used for severe lipodystrophy and found to significantly improve metabolic abnormalities. This new option for therapy is leptin, an adipocyte hormone, which may improve insulin resistance, hyperglycemia, dyslipidemia, and hepatic steatosis. Leptin is the first of a group of adipocyte-secreted hormones to be used clinically. Its long-term efficacy in 15 patients with generalized lipodystrophy was evaluated.
Leptin has been judged the first novel, effective, long-term treatment for severe forms of lipodystrophy. Treating severe lipodystrophy as a leptin deficiency syndrome has been shown to improve the metabolic outcomes in those affected patients.
In February 2014, the FDA approved metreleptin (Myalept), a recombinant leptin analog, for congenital or acquired generalized lipodystrophy in children and adults.. The approval was based on results from an NIH open-label, single-arm study that included 48 patients with congenital or acquired generalized lipodystrophy who also had diabetes mellitus, hypertriglyceridemia, and/or elevated levels of fasting insulin. The trial showed reductions in fasting glucose and triglycerides.
Metreleptin is not indicated for the following:
Treatment of complications of partial lipodystrophy
Treatment of liver disease, including nonalcoholic steatohepatitis (NASH)
Use in patients with metabolic disease, including diabetes mellitus and hypertriglyceridemia, without concurrent evidence of generalized lipodystrophy
Surgical intervention may be helpful for patients with deformities.
Consult specialists to manage the variety of medical problems that can occur.
The limited ability to store energy as fat means patients with generalized lipodystrophy must maintain a rigid special diet with 4 regular-sized meals each day.
A common cause of death has been GI hemorrhage from esophageal varices in association with hepatic failure. Renal complications are frequent causes of death in the congenital form. Frequently, patients with the acquired form also die in middle age from GI hemorrhage due to esophageal varices.
Delayed emergence from anesthesia has been described in a child with congenital generalized lipodystrophy (Berardinelli-Seip syndrome).
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