Localized Lipodystrophy Clinical Presentation

Updated: May 02, 2017
  • Author: Serhat Aytug, MD; Chief Editor: George T Griffing, MD  more...
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Presentation

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. [11]

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