Localized Lipodystrophy Workup
- Author: Serhat Aytug, MD; Chief Editor: George T Griffing, MD more...
Laboratory Studies
- No specific laboratory blood tests exist to diagnose lipodystrophy.
- Serological markers of systemic connective tissue diseases can be present with the inflammatory type of lipodystrophies.
Imaging Studies
No specific imaging study to diagnose localized lipodystrophy exists.
Other Tests
Histopathological examination is the hallmark of diagnosis.
Procedures
Obtaining a biopsy of lesions is the diagnostic procedure of choice, and performing a histopathological examination might be helpful to diagnose and guide the treatment.
Histologic Findings
Histology depends on the type of lipodystrophy. According to one study, 2 main histopathological subsets exist.[9] One form, termed involutional fat, is a distinctive picture characterized by lobules of small lipocytes embedded in hyaline connective tissue, peripheral lobular accentuation, absence or scarcity of inflammatory cells, and myxoid stroma with numerous capillaries. Most of the patients with this type of histology have a single lesion, usually of the upper arm. Results of serological studies are normal. Of 3 cases in which direct immunofluorescence was performed, only one patient showed immunoreactants in the blood vessels.
The other type of histology is more of an inflammatory type, with inflammation of the fat. Normal-appearing lipocytes and normal vasculature are present, as well as scattered focal lymphocytes, histiocytes, and plasma cells. This histology involves multiple areas of localized lipoatrophy. In the early biopsy specimens of a series of 4 patients, lymphocytic panniculitis was observed, emphasizing the inflammatory basis for this disorder.[10]
Staging
Classification of partial or localized lipodystrophy involves association with the following:
- Nephritis with low complement levels (membranoproliferative glomerulonephritis)
- Scleroderma
- Sjögren syndrome
- Systemic lupus erythematosus
- Recurrent pyogenic infections
- Thyroiditis secondary to intradermal or subcutaneous injections
- Injection of insulin, corticosteroids, and other medications (eg, IM penicillin G, iron dextrans, diphtheria/pertussis/tetanus vaccine, acupuncture, recombinant growth hormone injections)
- Lipoatrophy secondary to panniculitis of connective tissue disease
- Lupus panniculitis/profundus
- Lymphocytic connective tissue panniculitis
- Localized lipoatrophy
- Annular lipoatrophy
- Abdominal lipoatrophy
- Atrophic panniculitis
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