Localized Lipodystrophy Clinical Presentation

  • Author: Serhat Aytug, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Jan 3, 2012
 

History

Localized lipodystrophy usually presents as isolated or multiple, atrophic, depressed areas with induration and indentations typically found in the extremities and other parts of the body in early childhood. These lesions may expand and, sometimes, spontaneously disappear. Lesions usually have no overlying skin changes and might have secondary skin pigmentations. Patients generally do not have any underlying diseases or associated symptoms at the time of presentation.

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Physical

  • Localized lipodystrophy typically presents as depressions of the skin in various areas; lesions are multifocal, well-demarcated, and atrophic.
    • Lesions can be pigmented or nonpigmented, and they usually are painless.
    • Lesions can be as big as 15 cm in diameter.
    • Lesions tend to be located proximally, ie, buttocks, thighs, and upper arms are involved more frequently than lower legs are. The face, scalp, breasts, distal aspects of the extremities, and mucous membranes tend to be spared.
  • Some patients have local panatrophy involving muscle, fat, and morphealike changes.
    • Local panatrophy can present as panatrophy that includes the manifestation of hemifacial atrophy.
    • One subset group has annular atrophy of the ankles and semicircular lipoatrophy of the anterolateral region of the thighs. These signs can be observed in subcutaneous and intradermal injection sites.
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Causes

The cause of lipodystrophic syndromes is unknown. One subset of the lipodystrophic syndromes is associated with subcutaneous and intradermal injection sites. In this group, trauma may induce the release of macrophage cytokines (eg, tumor necrosis factor, interleukin-1) that might enhance lipocyte catabolism. Impure animal insulin might lead to localized lipodystrophy, possibly because of a cross-reaction with lipid tissues and insulin antibody. Localized lipodystrophy caused by a cross-reaction is very rare with synthetic insulin.[8]

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Contributor Information and Disclosures
Author

Serhat Aytug, MD  Staff Physician, Division of Endocrinology, Diabetes and Metabolism, Crystal Run Healthcare

Serhat Aytug, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, and Pituitary Society

Disclosure: Nothing to disclose.

Coauthor(s)

Rubens Sievert, MD  Clinical Assistant Professor, Department of Internal Medicine, Mount Sinai School of Medicine

Rubens Sievert, MD is a member of the following medical societies: American Thyroid Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David M Klachko, MD, MEd  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Missouri-Columbia School of Medicine

David M Klachko, MD, MEd is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Federation for Medical Research, Endocrine Society, Missouri State Medical Association, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS  Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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  2. Touraine P, D'Souza GA, Kourides I, et al. Lipoatrophy in GH deficient patients treated with a long-acting pegylated GH. Eur J Endocrinol. Oct 2009;161(4):533-40. [Medline].

  3. Winkelmann RK, Padilha-Goncalves A. Connective tissue panniculitis. Arch Dermatol. Mar 1980;116(3):291-4. [Medline].

  4. Gdynia HJ, Weydt P, Ernst A, et al. Myositis associated with localized lipodystrophy: an unrecognized condition?. Eur J Med Res. May 14 2009;14(5):228-30. [Medline].

  5. Hisamichi K, Suga Y, Hashimoto Y, Matsuba S, Mizoguchi M, Ogawa H. Two Japanese cases of localized involutional lipoatrophy. Int J Dermatol. Mar 2002;41(3):176-7. [Medline].

  6. Yamamoto T, Yokozeki H, Nishioka K. Localized involutional lipoatrophy: report of six cases. J Dermatol. Oct 2002;29(10):638-43. [Medline].

  7. Soos N, Shakery K, Mrowietz U. Localized panniculitis and subsequent lipoatrophy with subcutaneous glatiramer acetate (Copaxone) injection for the treatment of multiple sclerosis. Am J Clin Dermatol. 2004;5(5):357-9. [Medline].

  8. Peteiro-González D, Fernández-Rodríguez B, Cabezas-Agrícola JM, Araújo-Vilar D. Severe localized lipoatrophy related to therapy with insulin analogs in type 1a diabetes mellitus. Diabetes Res Clin Pract. Mar 2011;91(3):e61-3. [Medline].

  9. Winkelmann RK, Frigas E. Eosinophilic panniculitis: a clinicopathologic study. J Cutan Pathol. Feb 1986;13(1):1-12. [Medline].

  10. Winkelmann RK. [Panniculitis with cellular phagocytosis. Chronic form of histiocytic panniculitis with fever, pancytopenia, polyserositis and lethal hemorrhagic diathesis]. Hautarzt. Nov 1980;31(11):588-94. [Medline].

  11. Gassling VL, Douglas T, Wiltfang J, et al. Unilateral atrophy of the cheek: autologous fat injection as treatment of choice. J Craniofac Surg. Mar 2009;20(2):423-5. [Medline].

  12. Buyukgebiz A, Aydin A, Dundar B, Yorukoglu K. Localized lipoatrophy due to recombinant growth hormone therapy in a child with 6.7 kilobase gene deletion isolated growth hormone deficiency. J Pediatr Endocrinol Metab. Jan-Feb 1999;12(1):95-7. [Medline].

  13. 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].

  14. Drago F, Rongioletti F, Battifoglio ML, Rebora A. Localised lipoatrophy after acupuncture. Lancet. May 25 1996;347(9013):1484. [Medline].

  15. Koshy CE, Evans J. Facial contour reconstruction in localised lipodystrophy using free radial forearm adipofascial flaps. Br J Plast Surg. Oct 1998;51(7):499-502. [Medline].

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

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

  18. Serrao VV, Feio AB. Localized abdominal idiopathic lipodystrophy. Dermatol Online J. Jul 15 2008;14(7):15. [Medline].

 
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