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Lipoatrophy is an uncommon condition in which fat layers just underneath the skin start to disappear. The problem can occur in an isolated body part, such as the face or an arm, or cause widespread fat tissue 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 for each patient and largely depend on the underlying causes.
A person who suffers from this condition is likely to have noticeable depressions in the skin where fat is lost. Bone, ligament, and muscle tissue underneath the site become more defined when protective subcutaneous fat disappears. The area inside a dent may be tender to the touch, and the skin can become slightly darker or lighter than surrounding skin tissue. Other symptoms, including fever, pain, and fatigue, may be present in some cases.
Most episodes of localized lipoatrophy are related to medication injections. A corticosteroid shot given to ease inflammation, pain, and swelling following injury can cause problems if it is injected into fat rather than muscle tissue. Diabetic patients who use insulin may experience indentations if they repeatedly inject their medications at the same site. Copaxone, a common treatment for multiple sclerosis, is also associated with lipoatrophy. Finally, oral HIV medications can impair healthy fat cell production in the face, buttocks, or extremities as a side effect of their intended function.
Other causes are not well understood, but they are occasionally linked with other disorders. Severe viral illnesses such as chickenpox, rheumatoid arthritis, lupus, and hypothyroidism can result in subcutaneous fat loss in young children and teenagers. In addition, a very rare genetic mutation can impair the production and preservation of fat cells underneath the skin, causing symptoms to appear in infancy.
Doctors can usually detect lipoatrophy fairly easily by evaluating the physical appearance of skin indentations. In the case of localized fat loss, specialists carefully review patients' medical histories and current medication use. Computerized tomography scans, x-rays, and blood tests are performed to look for possible causes and gauge the severity of widespread lipoatrophy.
After making a diagnosis, a doctor may decide to adjust a patient's HIV medications or start injecting insulin into different body parts. Anabolic steroids may be given to help re-stimulate fat cell production. If problems are widespread, severe, or do not get better 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. Using donor fat tissue or synthetic implants may also be considered.