Lipoatrophy as a manifestation of different clinical scenarios: corticosteroid injection, lupus profundus and morphea induced lipoatrophy.
DOI:
https://doi.org/10.66344/jpad.v32i3.1986Abstract
Objective To report the frequency of different types of acquired dermolipoatrophy in relation to different etiological factors.
Methods In this observational case series descriptive study, twenty nine patients with different clinical forms of acquired lipoatrophy were enrolled during the period from 2006-2020. For every patient, a full history and complete systemic and cutaneous examination were performed. Laboratory investigations were done, when needed.
Results Twenty nine patients with localized lipoatrophy, 16 (55.2%) females, 13 (44.8%) males, with ages range from 3-55 years (mean 16.7 years) were evaluated and analyzed. The current work showed that intralesional and intramuscular triamcinolone injection was the most frequent cause responsible for development of localized lipoatrophy in 27 (93.1%) patients followed by morphea and lupus profundus in only 1 (3.45%) patient for each .With regard to corticosteroid induced lipoatrophy, the buttock was the most commonly affected site in 14 (51.9%) patients and all the affected patients were children while the scalp was involved in 12 (44.4%) patients and forearm in 1 (3.7%) patient.
Conclusion Lipoatrophy following intramuscular and intralesional corticosteroid preparation particularly triamcinolone acetonide is an important and common cause for acquired lipoatrophy with significant psychological sequelae for the affected patients and/ or their parents. Also lupus profundus and linear morphea are important diseases to be considered while evaluating patients with acquired lipoatrophy.
References
1. Bindlish S, Presswala LS, Schwartz F. Lipodystrophy: Syndrome of severe insulin resistance. Postgrad Med. 2015;127(5):511-6.
2. Fiorenza CG, Chou SH, Mantzoros CS. Lipodystrophy: pathophysiology and advances in treatment. Nat Rev Endocrinol. 2011;7(3):137-50.
3. Garg A. Lipodystrophies. Am J Med. 2000; 108(2):143-52.
4. Hussain I, Garg A. Lipodystrophy Syndromes. Endocrinol Metab Clin North Am. 2016;45(4):783-97.
5. Chan JL, Oral EA. Clinical classification and treatment of congenital and acquired lipodystrophy. Endocr Pract. 2010; 16(2):310-23.
6. Misra A, Garg A. Clinical features and metabolic derangements in acquired generalized lipodystrophy: case reports and review of the literature. Medicine (Baltimore). 2003;82(2):129-46.
7. Pope E, Janson A, Khambalia A, Feldman B. Childhood acquired lipodystrophy: a retrospective study. J Am Acad Dermatol. 2006;55(6):947-50.
8. Ceccarini G, Magno S, Gilio D, Pelosini C, Santini F. Autoimmunity in lipodystrophy syndromes. Presse Med. 2021; 50(3):104073.
9. James J, Carruthers A, Carruthers J. HIV-associated facial lipoatrophy. Dermatol Surg. 2002;28(11):979-86.
10. Garg A. Clinical review: Lipodystrophies: genetic and acquired body fat disorders. J Clin Endocrinol Metab. 2011;96(11):3313-25.
11. Herranz P, de Lucas R, Pérez-España L, Mayor M. Lipodystrophy syndromes. Dermatol Clin. 2008;26(4):569-78.
12. Ramos AJ, Farias MA. Human insulin-induced lipoatrophy: a successful treatment with glucocorticoid. Diabetes Care. 2006;29(4):926-7.
13. Richards RN. Update on intralesional steroid: focus on dermatoses. J Cutan Med Surg. 2010;14(1):19-23.
14. Birnbaum A, Yoon MY, Struhl S. Serial saline solution injections for the treatment of lipoatrophy and depigmentation after corticosteroid injection for medial epicondylitis. JSES Int. 2020;4(4):1002-5.
15. Sharma RK, Gupta M, Rani R. Delineating injectable triamcinolone-induced cutaneous atrophy and therapeutic options in 24 patients-a retrospective study. Indian Dermatol Online J. 2022;13(2):199-206.
16. Valdatta L, Cherubino M, Tamborini F, Pellegatta I, Maggiulli F: A case of facial lipoatrophy secondary to lupus profundus managed with lipofilling technique. Case Rep Dermatol Med. 2012;2012:720518.
17. Castrillón MA, Murrell DF. Lupus profundus limited to a site of trauma: Case report and review of the literature. Int J Womens Dermatol. 2017;3(2):117-20.
18. Sharquie K E, Noaimi A A, Abdulqader E T, Aljanabi W K. Clinical and histopathological evaluation of pigmented morphea with new insight in relation to etiopathogenesis of the disease. Am J Dermatol Venereol. 2020;9:21-6.
19. Fett N, Werth VP. Update on morphea: part I. Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 2011; 64(2):217-28; quiz 229-30.
20. Chang CH, Fang KT, Hong SJ. Morphea-like localized involutional lipoatrophy-a case report associated with family history. Dermatol Sinica. 2010;28:113–6.
21. Kutlu Ö, Ozdemir Cetinkaya P. Autologous blood injection for treatment of steroid atrophy: A case report. J Cosmet Dermatol. 2021;20(10):3253-6.
22. Dhinsa H, McGuinness AE, Ferguson NN. Successful treatment of corticosteroid-induced cutaneous atrophy and dyspigmentation with intralesional saline in the setting of keloids. JAAD Case Rep. 2021;16:116-9.
23. Margulies SL, Morris A. Successful treatment of lipoatrophy with normal saline. JAAD Case Rep. 2015;1(6):415-7.
24. Shumaker PR, Rao J, Goldman MP. Treatment of local, persistent cutaneous atrophy following corticosteroid injection with normal saline infiltration. Dermatol Surg. 2005;31(10):1340-3.
25. Huang HP, Huang YC, Tzeng YS, Wang CH, Chen TM, Chen SG. Autologous fat grafting for treating lipoatrophy secondary to lupus erythematosus panniculitis. Formos J Surg. 2016;49(1):27-30.
26. Zanelato TP, Marquesini G, Colpas PT, Magalhães RF, Moraes AM. Implantation of autologous fat globules in localized scleroderma and idiopathic lipoatrophy--report of five patients. An Bras Dermatol. 2013;88:120-3.
27. Mendiratta V, Bansal M, Rana S, Aggarwal K. Lipoatrophic linear morphea in a 5-year-oldgirl:A novel variant? Indian J Paediatr Dermatol. 2021;22:346-8.
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