Lipoatrophy

What is Lipoatrophy?

Lipoatrophy is a condition that is characterized by loss of fat in your body. Lipoatrophy is not a disease, but it is a result of other conditions, which cause loss of fat in your body. This condition does not cause cancer and its severity depends on the involved organ.

Lipoatrophy can occur at any age and it is most common in females because they have fewer muscles under the subcutaneous layer.

Types

There are various types of lipoatrophy and they include:

Localized

This type of lipoatrophy is where one or more areas of your body lose fat. It is most common and manifests in patients who receive multiple subcutaneous injections.

Partial

This is an even loss of fat in your face, trunk and arms. This form of lipoatrophy is as a result of renal diseases, immunologic disorders, hyperlipidemia and diabetes.

An example is facial lipoatrophy, which manifests in form of fat loss in your face and it can be seen in areas such as the temples, the cheeks, the nasolabial regions, and in some severe cases, it occurs in the orbits.

Total

This form of lipoatrophy can be acquired or congenital and it results in complete loss of your adipose fat tissue. It can be acquired which you get as a result of other conditions or congenital which you develop from birth. It is caused by hypermetabolism, hyperlipidemia and insulin resistance.

Symptoms

A person with lipoatrophy may exhibit one or more of the following symptoms:

• You lose fat under your skin, arms, and legs and make your veins appear high on the skin.
• You may develop sunken cheeks and temples due to loss of fat in the face
• You may experience pain and tiredness while walking due to loss of fat in the soles of your feet.
• You can develop pigmented or non-pigmented lesions
• You can have both single and multifocal depression in the skin.

Causes

The exact cause of lipoatrophy is unknown. Some of the likely causes include:

Congenital lipoatrophy

Mutated genes

You can develop lipoatrophy when one of your family members had genes of lipoatrophy.

Acquired lipoatrophy

Acquired lipoatrophy is caused by the following:

a)Medications

When you receive recurrent injections on one spot of your body, the macrophages release cytokines, which lead to breakdown of your adipose tissue causing lipoatrophy. There are many medicines that are injected through the subcutaneous layer such as heparin, insulin injection and human growth hormone injections.

b)Autoimmune diseases

Immune system disorders affect the activities of your immune system; it can lead to low or over activity. When your immune system experiences over activity, your body produces antibodies that attack and damage its own tissues. This is called autoimmune disease. The following are some of autoimmune diseases:

Inflammatory bowel disease

Your immune system attacks the intestine linings causing diarrhea, pain in the abdomen, fever, rectal bleeding.

Rheumatoid arthritis

Your immune system attacks the joints leading to pain, swelling and inflammation.

Multiple sclerosis (MS)

Your immune system attacks the nerves which can lead to blindness, poor coordination and muscle spasms.

Type 1 diabetes mellitus

Your immune system attacks and destroys insulin producing cells in the pancreas.

Dermatomyositis

It is an inflammatory condition that can cause skin rash, weaken muscles, swelling of myopathy or muscles. The exact cause of this condition is unknown but it has many similarities with an autoimmune disease.

Diagnosis

Your doctor can confirm diagnosis of lipoatrophy by assessing your physical symptoms and your body (face, leg, etc).

Treatment

There are no medications or diet for treating lipoatrophy. But surgery intervention is the best choice to correct the problem.

Surgery

A doctor can harvest fat in any of your parts of the body, clean, filter and inject or surgically implant it on another part of the body such as the face to correct the depression on your skin. Your doctor can use the following to treat your facial lipoatrophy condition:

Bovine and human collagen

Bovine collagen is particularly taken from calf skins, but with human collagen, it is grown in vitro by use of human tissues. Bovine causes allergic reactions and before it is injected in your face, the doctor conducts an allergic test on you.

Collagen injections are widely available globally which means you can get them in a hospital near you or from plastic surgeons and dermatologists. Other demerits of collagen injections include frequent visit to your surgeon for touch –ups because collagen injections last for a short time usually three months.

Human Cadaveric Dermis and fascia

They are gotten from cadaveric. The dermis or muscle fascia is extracted before being sterilized and tested after which it is processed. Cadaveric dermis and fascia are used to fill hollows in your face as a result of lipoatrophy and they are readily available.

Hyaluronic Acid

This may be in form of restylane, restylane SubQ, perlane, or hylaform. Hyaluronic acid is naturally found in human connective tissues. These products are synthetic versions of hyaluronic acid and are used to ensure the body does not break them down rapidly.

In HIV-positive individuals with lipoatrophy, hyaluronic acid injections last for six to 12 months. They are cheaper for long term than many other products and you need fewer touch-ups. It is possible to reverse hyaluronic acid fillers though hyaluronidase (Vitrase) injections. You can find it unease to recover from post-injection.

Patients with moderate –to-severe facial lipoatrophy require large volumes of the injection to achieve optimal results. Restylane SubQ gives good results in filling your subcutis but unfortunately it is not readily available.

Calcium Hydroxylapatite

This may be in form of Radiesse. These products have synthetic calcium hydroxylapatite, which is a natural substance you find in teeth and bones.

It is injected into your dermis layer of the skin and forms natural collagen around the calcium hydroxylapatite that provides you with a long-term and natural looking skin. This medication can cause nodules at the site of your injection and it is also expensive.

New-fill or Sculptra

It is used to stimulate the growth of collagen and develop thick skin layer that covers the wasted areas of your cheek. Collagen is a structural part of the skin and other body tissues. Most people require 4-5 sets of sculptra injections for the change to be seen. You have to continue with injections for several months to achieve a good looking skin.

After being injected, you will be offered a massage to ensure proper placement and reduce nodules as well as icing to limit swelling. Sculptra is safe and effective in managing people with HIV associated lipoatrophy.

In essence, while medication may not help in treating lipoatrophy patients, surgery interventions can provide relief to patients with this disorder.

Pictures

Submalar Implant

Reference List

1. http://healthzene.com/lipoatrophy/
2. http://www.webmd.com/diabetes/acquired-lipodystrophy
3. https://www.sclero.org/scleroderma/autoimmune/skin-diseases/lipodystrophy/a-to-z.html
4. http://www.mayoclinic.org/medical-professionals/clinical-updates/endocrinology/lipodystrophy-syndromes-new-treatment-newer-questions
5. http://emedicine.medscape.com/article/123125-overview
6. lipoatrophy – http://www.webmd.com/hiv-aids/tc/hiv-highly-active-antiretroviral-therapy-haart-topic-overview