Lipodystrophy

A 1-year history of “dents” on her body prompted a 40-year-old African American woman to seek medical evaluation. Her medical history was unremarkable; however, there was a strong family history of severe type 2 diabetes mellitus. The patient denied having received or having self-administered injections into the affected areas. She reported no history of deep, tender nodules at the sites. Many large, well-defined, depressed areas were noted on the upper arms (A), hips (B), and thighs. Laboratory data were unrevealing; a biopsy of a skin specimen from an affected site disclosed merely the noninflammatory loss of adipocytes. Dr Ted Rosen of Houston writes that this patient had lipodystrophy, or lipoatrophy—the absence of subcutaneous fat. This condition, which can be hereditary or sporadic and limited or generalized, is often associated with acanthosis nigricans, hypertriglyceridemia, and hyperglycemia. Hepatomegaly and renal dysfunction may accompany generalized lipodystrophy. Localized disease can occur after blunt trauma or subcutaneous injections. The condition also may be the end stage of various forms of inflammatory panniculitis, including lupus profundus. This patient’s family history strongly suggested that her lipodystrophy was a forme fruste of hereditary disease. Her serum glucose and lipid levels are monitored periodically. There is no effective medical therapy for the larger depressed areas of skin; smaller lesions can be removed surgically.