Lipoatrophy is a rare condition where fat layers under the skin disappear, often caused by corticosteroid or insulin injections, HIV drugs, or genetic disorders. Treatment options vary depending on the cause and severity, including changing medications, anabolic steroids, or cosmetic surgery.
Lipoatrophy is a rare condition in which the layers of fat just under the skin begin to disappear. The problem can occur in an isolated part of the body, such as the face or arm, or cause widespread fat loss. Many different factors can be involved in localized lipoatrophy, including corticosteroid shots, insulin injections for diabetes, and some human immunodeficiency (HIV) drugs. Widespread problems are usually the result of inherited genetic disorders. Treatment decisions are unique to each patient and depend largely on the underlying causes.
A person suffering from this condition is likely to have obvious depressions in the skin where fat is lost. The bone, ligament, and muscle tissue beneath the site become more defined as the protective subcutaneous fat disappears. The area inside a dent may be tender to the touch, and the skin may become slightly darker or lighter than the surrounding skin tissue. Other symptoms, including fever, pain and fatigue, may be present in some cases.
Most episodes of localized lipoatrophy are related to drug injections. A corticosteroid injection given to relieve inflammation, pain, and swelling following an injury can cause problems if injected into fat rather than muscle tissue. Diabetic patients who use insulin may experience indentations if they repeatedly inject the drugs into the same site. Copaxone, a common treatment for multiple sclerosis, is also associated with lipoatrophy. Finally, oral HIV medications can impair the production of healthy fat cells in the face, buttocks, or extremities as a side effect of their intended function.
Other causes are not well understood, but are occasionally linked to other disorders. Serious viral diseases such as chickenpox, rheumatoid arthritis, lupus, and hypothyroidism can lead to loss of subcutaneous fat in children and adolescents. Furthermore, a very rare genetic mutation can impair the production and storage of fat cells under the skin, causing symptoms to appear in childhood.
Doctors can usually detect lipoatrophy fairly easily by assessing the physical appearance of the skin indentations. In cases of localized fat loss, specialists carefully review the patient’s medical history and current medication use. Computed tomography scans, x-rays, and blood tests are done to look for possible causes and assess the severity of diffuse lipoatrophy.
After making a diagnosis, a doctor may decide to change a patient’s HIV medications or start injecting insulin into different parts of the body. Anabolic steroids can be administered to help stimulate the production of fat cells again. If problems are widespread, severe, or don’t improve with conservative treatment, a patient may be eligible for a cosmetic surgery procedure. A surgeon can transfer excess fat from the buttocks or another part of the body to the site of the disfiguring dent. The use of donor fat tissue or synthetic implants may also be considered.
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