eMedicine Specialties > Endocrinology > Metabolic Disorders

Lipodystrophy, Localized: Follow-up

Author: Serhat Aytug, MD, Staff Physician, Division of Endocrinology, Diabetes and Metabolism, CrystalRun Healthcare
Coauthor(s): Rubens Sievert, MD, Clinical Assistant Professor, Department of Internal Medicine, Mount Sinai School of Medicine
Contributor Information and Disclosures

Updated: Oct 29, 2009

Follow-up

Further Inpatient Care

No specific inpatient care is necessary.

Further Outpatient Care

Follow-up of lesions with biopsies to determine disease activity and obtaining serological markers for immunological disorders might be helpful to guide the treatment.

Deterrence/Prevention

No known method for prevention exists. Controlling the underlying immunological disorder might be preventative.

Complications

  • Loss of subcutaneous tissue
  • Cosmetic complications

Prognosis

  • Prognosis is usually benign. Mortality and morbidity depends on associated organ system involvement and comorbid conditions.
  • Patients without other organ system involvement experience no disability and are anticipated to have a normal life expectancy.

Patient Education

  • No specific care is required.
  • Patients can be taught to change insulin injection sites if lipodystrophy is related to insulin injections.

Miscellaneous

Medicolegal Pitfalls

  • Patients with localized lipodystrophy can have underlying immunological disorders and connective tissue diseases, such as systemic lupus erythematosus, nephritis, Sjögren syndrome, scleroderma, morphea, nephritis, hypocomplementemia, recurrent pyogenic infections, thyroiditis, and ITP. Therefore, localized lipodystrophy should alert physicians to these diseases and disorders. Prompt and appropriate workup is necessary where clinically indicated.
  • Recognize localized lipodystrophy at intramuscular, intradermal, and subcutaneous injection sites early and avoid injections in these sites. Insulin lipodystrophy usually occurs at the injection sites, but, sometimes, it occurs elsewhere.
    • Insulin lipodystrophy is more prevalent in females and in patients younger than 20 years.
    • Insulin lipodystrophy usually occurs 3-6 months after initiation of insulin therapy.
    • Before the availability of highly purified insulin, this complication occurred in about 20% of patients.
    • The precise mechanism of insulin lipodystrophy is not understood; however, the mechanism probably is due to an immunologic reaction to impurities in insulin.
    • Insulin lipodystrophy is rare in patients using purified insulin.
    • The absorption of insulin from such areas is unpredictable and may cause erratic or poor glucose control.
    • Although patients usually respond to purified insulin, occasionally, no response to purified insulin occurs. If no response occurs, the addition of dexamethasone to the insulin may be helpful (4 mcg/U).

Special Concerns

  • Cosmetically, lipodystrophy can be disturbing. In extreme cases, body self-image can be significantly impaired.
 


More on Lipodystrophy, Localized

Overview: Lipodystrophy, Localized
Differential Diagnoses & Workup: Lipodystrophy, Localized
Treatment & Medication: Lipodystrophy, Localized
Follow-up: Lipodystrophy, Localized
References
Further Reading
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References

  1. 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].

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

  3. 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].

  4. 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].

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

  6. 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].

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

  8. 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].

  9. 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].

  10. 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].

  11. 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].

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

  13. 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].

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

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

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

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Keywords

localized lipodystrophy, lipodystrophy, lipoatrophy, adipose tissue, atrophic lesions, tissue atrophy, lipoatrophic, fat lesions, fat lesion

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Contributor Information and Disclosures

Author

Serhat Aytug, MD, Staff Physician, Division of Endocrinology, Diabetes and Metabolism, CrystalRun Healthcare
Serhat Aytug, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, 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.

Medical Editor

David M Klachko, MBBCh, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri
David M Klachko, MBBCh 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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 Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, American Society of Law Medicine and Ethics, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

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.

 
 
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