Lipoatrophy semicircularis induced by trauma

Semicircular Lipoatrophy: A Case Series With Follow-up of 76 Patients in Madrid and a Proposed Classification

BACKGROUND AND OBJECTIVE

The clinical presentations of semicircular lipoatrophy (SL) vary, and diagnostic criteria are unclear. Several etiopathogenic factors, including occupational environmental ones, have been suggested. We aimed to describe a cluster of cases of suspected SL that started to appear in May 2008 among employees of the city council of Madrid, Spain. We report the actions taken by the council's occupational health service and propose clinical categories with prognostic implications.

MATERIAL AND METHODS

Observational study of retrospectively identified patients that includes prospectively collected case data. Cases between 2008 and 2021 were identified for review by the city council's service for dermatology and prevention of sexually transmitted infections. Information on measures taken by the occupational health service and clinical data were analyzed for descriptive statistics and detection of clinical patterns to aid classification.

RESULTS

We studied the cases of 75 women and 1 man, most of whom attended follow-up visits for a median of 37 months. Local symptoms were observed in just 14.5% of patients. The cases were classified into 4 groups: typical SL, unilateral SL, band-like lipoatrophy in the lower limbs, and nonspecific SL. Clinical outcomes were more often favorable in the first 2 groups, in which 76% of patients achieved total or partial improvement of lesions (vs. 25.8% in the last 2 groups). SL was negatively associated with the presence of hypertrophic subcutaneous adipose tissue (P < .001).

CONCLUSIONS

Typical SL, which can often be unilateral, generally has a satisfactory outcome. The clinical characteristics of this form distinguish it from other types of lipoatrophy. Measures taken by the occupational health service contributed to favorable outcomes. In this series, SL was not associated with marked subcutaneous adipose tissue hypertrophy in the thighs. Our proposed categories may help distinguish between cases of SL with a favorable prognosis and other SL types in which skin surface depressions form and are often persistent.

Semicircular lipoatrophy: an electrostatic hypothesis

BACKGROUND

Semicircular lipoatrophy (SL) is a benign pathology characterized by subcutaneous adipose tissue atrophy.

OBJECTIVE

To determine causes of SL.

METHODS

We performed research on 42 cases of SL who had developed symptoms of lipoatrophy with a technical study of the building and clinical study of the affected patients.

RESULTS

Electromagnetic field and electrostatic charge measurements were performed. No signals different from typical radio, TV and other wireless communication devices were recorded. Electrostatic charges were recorded in floors, environments and on different furniture; they were positive, and all charges disappeared on contact with the worker's skin. Data about the workplace were collected, and clinical examinations were performed, including blood and biochemistry tests and 18 ultrasound skin tests.

CONCLUSIONS

As no abnormal electromagnetic measurements were found and electrostatic changes and occupational behaviors showed some relevant data and as after changes in order to control the electrostatic environment all of them improved, we can conclude that electrostatic charges but not electromagnetic ones are the main cause of SL.

Is lipoatrophia semicircularis a rare disease? Report of three cases

Lipoatrophia semicircularis is characterised by band-like horizontal skin depressions involving the anterior and lateral sides of the lower limbs. Whether this occurrence is rare or is just not well known or simply underreported because it does not cause patient distress is still under discussion. In a 1-year period we observed three cases due to local, mechanical pressure in an Italian dermatology outpatient clinic. However, other factors described in current literature may contribute to this phenomenon. More large-scale studies are needed to clearly assess the origin of this condition.

[Lipoatrophia semicircularis: a case report]

We report a 54-year-old man who presented bilateral, symmetric depressions on the anterior aspect of his thighs corresponding to lipoatrophia semicircularis. The origin of this distinctive variant of lipoatrophy is unknown. Repeated external microtraumatisms were considered to be the most plausible explanation. Recently, as many recently affected subjects shared a status of administrative employee, the role of electromagnetic fields generated by computers and their wirings has been discussed. Prevention proposal includes adapting work environment related to the use of computerized devices.

Symptomatic fat necrosis and lipoatrophy of the posterior pelvis following trauma

Posttraumatic fat necrosis and lipoatrophy can occur in the subcutaneous fat following falls, blunt injury, surgery, and minor procedures or injections. While these processes have no inherent serious medical consequences, they occasionally require treatment due to severe or concerning symptoms. Three patients (all women; average age, 47 years) who sustained blunt trauma to the pelvis and were diagnosed with posttraumatic fat necrosis or lipoatrophy were retrospectively identified from our orthopedic oncology records. All patients recalled blunt trauma to the posterior pelvis just prior to symptom onset; 2 patients fell down stairs and 1 fell from a bed. Chief symptoms were a painful mass, a painless mass, and chronic pain in the injured area. Magnetic resonance imaging (MRI) revealed atrophy of the subcutaneous fat in all cases and a small mass in 1 patient. A bright linear signal was seen on T2-weighted, fat-saturated images in 2 cases, likely representing scar tissue. One patient with chronic pain underwent surgery to provide better soft tissue coverage in the area of atrophic fat. The other 2 patients did not undergo surgical treatment: 1 was treated at a pain center for reflex sympathetic dystropy-type pain, and 1 remained pain free. Blunt trauma with subsequent fat atrophy and necrosis manifests as a mass, a subcutaneous fat defect, and even as chronic pain. Characteristic MRI findings are often sufficient for diagnosis, but any indeterminate masses should be further evaluated to rule out aggressive or malignant neoplasms. Chronic unrelenting pain despite treatment may be related to posttraumatic reflex sympathetic dystropy-like symptoms.

In vitro investigations related to the hypothesis that Lipoatrophia semicircularis finds its origin in electro-stimulation

Lipoatrophia semicircularis (L.s.) is an idiopathic condition characterized by semicircular impressions of the skin, usually at the front and sides of both thighs. It is characterized by atrophy of the subcutaneous adipocytes whereas the skin and muscles remain normal. L.s. was originally considered to be very rare but over the past 13 years an outburst of L.s. has been observed in companies in Belgium and later on also in companies in other countries (e.g., Spain) where several hundred individuals were diagnosed with L.s. All these subjects belonged to the administrative personnel and worked in renovated or new offices. Different hypotheses have been put forward to explain the appearance of Lipoatrophia semicircularis but the hypothesis of an 'electric' origin of L.s. is probably the best documented and plausible. The present study was aimed to further investigate the likelihood of this hypothesis. The alkaline comet assay was used to investigate DNA damage in cells of different origin following exposure to a (strong) electric current. It was found that adipocytes showed more DNA damage than the other cells and hence that they are more vulnerable to such a current than macrophages and white blood cells. It was also found that DNA damage is significantly induced by an electric current in the blood from L.s. subjects whereas this is not so in blood from subjects without L.s. This may indicate that L.s. subjects are more responsive to an induced electric current and supports the hypothesis of an 'electric' origin of L.s.

Lipodystrophy syndromes

Lipodystrophy syndromes comprise a group of rare, heterogeneous disorders characterized by progressive loss of fat tissue, mainly from subcutaneous compartment and occasionally affecting visceral fat. Lipoatrophy may be partial, localized, or generalized. The latter cases are usually accompanied by metabolic-related disorders, including insulin resistance, diabetes mellitus, hyperlipemia, progressive hepatic disease and anabolic state. Treatment for lipodystrophy has increased interest in recent years because a new lipoatrophic population-patients who have HIV-associated lipodystrophy--is much more numerous than the whole number of patients affected by classic lipodystrophy entities.

Lipoatrophia semicircularis: A compressive lipoatrophy consecutive to persistent mechanical pressure

Lipoatrophia semicircularis is an infrequent condition characterized by semicircular depressions of the anterolateral aspects of the thighs. The origin of this peculiar variant of lipoatrophy is unknown, although repeated mechanical trauma on the affected thighs has been advocated in many cases. A 57-year-old woman presented with a 1-year history of two bilateral, parallel, symmetric, asymptomatic depressions on the anterolateral aspect of her thighs. The patient worked as a cashier, permanently seated and almost always wearing trousers. The localization of lesions and their linear artifactual appearance perfectly matched with the strangling folds formed by trousers while being sat. Echotomographic examination revealed a loss of the normal echogenic pattern in the subcutaneous tissue of the affected areas. We believe that the anatomical adipose constitution of women's thighs predisposes that a persistent mechanical pressure induced by wearing trousers while being sat for long periods of time, originates a relative impaired circulation on a tenuous perfused tissue, and induces the development of lipoatrophia semicircularis.

Leg crossers' dimple: A form of localized lipoatrophy

We report eight individuals with localized lipoatrophy of the lateral lower leg that were seen by a single dermatologist in a 1-year period. All were asymptomatic and half had mild epidermal changes consistent with lichenification. Seven were an incidental finding during a general skin examination. All had a long-standing history of frequent leg crossing. The sites correlated with the area resting on the patella of the opposing knee. The depressions were larger on sides of leg-crossing preference. Only one had a significant rise in antinuclear antibodies, but this patient had no other clinical or serological abnormalities. This appears to be an extremely common yet previously unreported form of localized lipoatrophy.

[Electromagnetic lipolysis and semicircular lipoatrophy of the thighs]

INTRODUCTION

The semicircular lipoatrophy of the thighs is a disorder whose incidence remained rare for years. Only recently, an "epidemic" situation emerged, affecting hundreds of subjects who shared a status of administrative employee.

OBSERVATION

The older etiopathogenic hypotheses give way to a newer one implying the electromagnetic fields generated by computers and their wirings. The resulting modifications in the intrinsic bioelectrical properties of the skin could influence the biology of macrophages exhibiting lipophagic activity in the hypodermis. The electroactivation of these cells could lead to TNF-alpha release.

DISCUSSION

The semicircular lipoatrophy of the thighs is a problem that may affect an employee out of two. Rather than hoping an efficaceous drug therapy, prevention must be advocated by adapting the work conditions related to the use of computerized devices.

A new case of semicircular lipoatrophy associated with repeated external microtraumas and review of the literature

We present a new case of semicircular lipoatrophy whose lesions disappeared after 2 months of avoiding a repeated trauma in that area. It seems that this is the only associated aetiological factor, and this entity is perhaps a consequence of certain postural habits. The repeated microtraumas would damage the fatty tissue giving rise to the histopathological findings described, which are compatible with traumatic panniculitis. In conclusion, repeated microtraumas may be the aetiological factor in these cutaneous lesions. Other data in favour of this hypothesis are the disappearance of the lesions after avoiding the mechanical trauma, the fact that there were other affected people at work, and that this factor has also been identified in the majority of cases reported previously.