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Lipoatrophy - Skin in Child
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Lipoatrophy - Skin in Child

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Contributors: Amy Fox MD, David Dasher MD, Jeffrey D. Bernhard MD, Sarah Stein MD, Karen Wiss MD, Sheila Galbraith MD, Craig N. Burkhart MD, Dean Morrell MD, Lynn Garfunkel MD, Nancy Esterly MD
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Synopsis

Lipoatrophy is thought to be a post-inflammatory state where there is loss of subcutaneous fat. Predisposing conditions for lipoatrophy include panniculitis, exogenous pressure, injection of medication, and antiretroviral therapy for HIV. Lipoatrophy is also a normal contributor to the appearance of an aging face.

Localized lipoatrophy has been subcategorized into the following: annular, abdominal, semicircular, and post-injection. These subcategories aim at describing clinical presentation, with the exception of post-injection lipoatrophy. The cause of lipoatrophy in annular, abdominal, and semicircular categories is thought to be post-inflammatory.

Injection site lipoatrophy can be associated with insulin, corticosteroids, and antibiotics among others, and history is a key component of making this diagnosis. Lipoatrophy associated with HIV is thought to result from antiretroviral treatment, although the exact mechanism is unknown.

Codes

ICD10CM:
E88.1 – Lipodystrophy, not elsewhere classified

SNOMEDCT:
248315005 – Lipoatrophy

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Morphea – Can be hyper- or hypopigmented indurated plaques. Induration is a key clinical feature lacking in lipoatrophy, and biopsy of this condition is diagnostic with broadened compact collagen bundles in a "square"-shaped punch biopsy.
  • Atrophoderma of Pasini and Pierini – Blue to brown hyperpigmented atrophic plaques without induration that are often symmetric and bilateral. The transition from normal to involved skin is classically described as a "cliff drop." Symmetry of this disease can help diagnosis, as histology in this condition is often nonspecific.
  • Cold panniculitis can result in fat loss.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 02/12/2015
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Lipoatrophy - Skin in Child
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Lipoatrophy : Atrophy
Clinical image of Lipoatrophy
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