Localised lipoatrophy and lipodystrophy

Definition

Localised lipodystrophies are characterised by loss of subcutaneous tissue from small regions of the body. The term covers a heterogeneous group of conditions for which the prevalence varies according to the cause. Lipodystrophies caused by a poor injection technique when administering insulin are frequent. Differential diagnoses may include scleroderma, idiopathic dermal atrophy, idiopathic atrophoderma of Pasini and Pierini, and Gowers panatrophy. Localised lipodystrophy may also be associated with an iatrogenic cause linked to injection of other substances such as steroids, somatostatin, glatiramer acetate (administered for multiple sclerosis) or exogenous material. They are sometimes triggered by pressure or by panniculitis, such as nodular non-suppurative panniculitis (Weber-Christian syndrome). Dercum's disease (adiposis dolorosa) is a rare condition characterised by the progressive appearance of painful fatty deposits, generally in menopausal women presenting with obesity. Sclerodermiform lipodystrophy of the abdomen and thighs may be caused by a graft versus host reaction following a bone marrow allograft for a haematological disorder. Idiopathic causes are not rare. Treatment should revolve around elimination of the cause whenever possible: modification of the injection technique for insulin therapy, plastic surgery if necessary, or immunosuppressive therapy in case of a graft versus host reaction. Localised lipodystrophy associated with insulin therapy usually resolves in a few weeks after changing the site of injection and modification of the length of the needle. The prognosis depends on the cause but is more severe in case of panniculitis or a graft versus host reaction.

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