Lipodystrophia centrifugalis abdominalis infantilis in a Caucasian girl: report of a case with perieccrine inflammation

Centrifugal lipodystrophy on a spectrum with lupus erythematosus panniculitis in children and efficacy and safety of hydroxychloroquine: A clinicopathological study

This study aimed to investigate the relationship between centrifugal lipodystrophy (CLD) and lupus erythematosus panniculitis (LEP), and the efficacy and safety of hydroxychloroquine (HCQ) for treating CLD in children. A total of 29 cases clinically diagnosed as CLD (n=24) and CLD/LEP overlap (n=5) were enrolled and all were confirmed by skin biopsies of CLD and LEP. The clinicopathological findings, clinical outcomes and prognosis with the treatment of HCQ between CLD and LEP were compared. All 29 cases (male: female=1:1.6; median age at onset: 3 years) had cutaneous lesions of centrifugally expanding lipoatrophy, of which five cases overlapped with LEP lesions presented as erythematous indurated plaque (n=2), subcutaneous nodules (n=2) and alopecia along Blaschko's lines (n=1). Antinuclear antibodies were found in six (25.0%) CLD and two (40.0%) overlapped patients (P=.597). Histopathologically, of the 24 cases of CLD, 14 (58.5%) exhibited subcutis loss or mild lobular inflammation. Ten (41.7%) cases displayed lobular panniculitis with moderate to dense lymphohistiocytic infiltrate and plasma cells, similar to the five cases of overlap. Small clusters of CD123 positive plasmacytoid dendritic cells were found in 62.5% (5/8) of CLD and 66.7% (2/3) of overlap cases (P>.99). HCQ (5 mg/kg/d) treatment showed improvement in 91.3% (21/23) of CLD and all overlap cases, including 4 cases unresponsive to previous oral glucocorticosteroid treatment. Our findings suggested that CLD and LEP represent a spectrum within the same disease. HCQ (5 mg/kg/d) was effective and safe for treating CLD (age>1.5 years), and early treatment and a regular long-term follow-up are essential. This article is protected by copyright. All rights reserved.

Lipodystrophia Centrifugalis Abdominalis Infantilis: A Case in a Vietnamese Patient

BACKGROUND

Lipodystrophia centrifugalis abdominalis infantilis (LCAI) is an uncommon dermatological condition characterized by a centrifugally expanding area of lipoatrophy involving the lower abdominal area and is frequently associated with inguinal lymphadenopathy. The average age of onset is 4 years and female individuals from Japan, China, and Korea are affected more often.

OBJECTIVES

To report the first case of LCAI in a Vietnamese patient.

METHODS

A complete clinical assessment was done and a biopsy from the affected area was performed.

RESULTS

There was an atrophic, slightly hyperpigmented patch at the lower abdomen with prominent underlying vasculature. Inguinal lymphadenopathy was noted on the ipsilateral side. A biopsy showed a lobular panniculitis with fat necrosis and lymphohistiocytic infiltrate with scattered plasma cells and multinucleated giant cells.

CONCLUSION

To our knowledge, this is the first reported case of LCAI in a Vietnamese patient.

Lipodystrophia centrifugalis abdominalis infantilis: statistical analysis of 168 cases

Lipodystrophia centrifugalis abdominalis infantilis is a localized lipodystrophic disease affecting young children. A total of 168 cases were collected from dermatology literature. Where possible, details of the data were also obtained from the authors. Most of the patients were Japanese, Korean, or Chinese in origin. The Caucasian patients were from England, Italy, France, Germany, Spain, and the United States. The male-to-female ratio was 1:1.6. The depressed lesions developed during the first 4 years of life in the groin or axilla, surrounded by a slight erythematous change. Histologically, subcutaneous fatty tissue was lost or markedly decreased in the depressed areas, and marked or moderate mononuclear cell infiltration was observed in the fatty tissue of the surrounding erythematous area. The depressed lesions extended centrifugally to involve the abdominal or chest walls. However, in most cases, such enlargement spontaneously ceased by the age of 13 years. No drugs used were effective in preventing the enlargement of depressed lesions, but more than 60% of patients showed spontaneous improvement after the cessation of enlargement. Lipodystrophia centrifugalis abdominalis infantilis is a clinically and histologically distinct lipodystrophic disease affecting young children, mostly in Asian countries, but a few in Western countries.