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Semicircular lipoatrophy, also known as peripheral lipoatrophy, is a condition in which there is a loss of subcutaneous fat (fat under the skin) in specific, circular or semicircular patterns. It is most commonly seen in people with human immunodeficiency virus (HIV) infection and is a complication of antiretroviral therapy (ART).
There are several types of semicircular lipoatrophy, each with unique features and causes. Some of the most common types include:
- Facial lipoatrophy: This type is characterized by the loss of fat in the cheeks, temples, and around the eyes, causing a sunken, hollow appearance. It is often one of the first signs of lipoatrophy and can greatly affect a person’s self-esteem and quality of life.
- Limb lipoatrophy: This type affects the legs and arms, causing a loss of fat in these areas and leading to thin, bony limbs. In some cases, the skin may also become thin and translucent, exposing veins and tendons.
- Truncal lipoatrophy: This type affects the abdomen and back, causing a loss of fat in these areas and leading to a gaunt appearance. This type of lipoatrophy can also cause the skin to become lax and saggy, leading to a “bread loaf” appearance.
- Peripheral lipoatrophy: This type encompasses all the types mentioned above and refers to the loss of fat in the peripheral areas of the body, such as the face, limbs, and trunk.
Causes
There are several potential causes of this condition, which can be broadly categorized into infectious, metabolic, autoimmune, and iatrogenic (medically induced) causes. Below is a list of causes of semicircular lipoatrophy, along with brief explanations of each.
- HIV/AIDS: One of the most well-known causes of semicircular lipoatrophy is infection with the human immunodeficiency virus (HIV), which can cause body-wide lipoatrophy as well as other symptoms of AIDS.
- Tuberculosis: Tuberculosis (TB) is a bacterial infection that can cause lipoatrophy in some cases, particularly in people with weakened immune systems.
- Syphilis: Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. It can cause lipoatrophy in some cases, particularly if left untreated.
- Leprosy: Leprosy, also known as Hansen’s disease, is a chronic bacterial infection that can cause localized lipoatrophy in some cases.
- Lyme disease: Lyme disease is a bacterial infection caused by the bite of infected ticks. It can cause lipoatrophy in some cases, particularly if left untreated.
- Diabetes: People with uncontrolled diabetes can develop lipoatrophy, particularly in the legs and arms, as a result of the metabolic imbalances associated with the disease.
- Metabolic disorders: A number of metabolic disorders, such as Cushing’s syndrome, can cause lipoatrophy as a result of imbalances in hormones and other metabolic factors.
- Autoimmune disorders: Autoimmune disorders, such as lupus, can cause localized lipoatrophy in some cases as a result of the body attacking its own tissues.
- Lipodystrophies: Lipodystrophies are a group of rare genetic disorders that cause generalized or localized loss of body fat. Some forms of lipodystrophy can cause semicircular lipoatrophy.
- Sarcoidosis: Sarcoidosis is a chronic autoimmune disorder that can cause lipoatrophy in some cases, particularly if it affects the skin.
- Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune disorder that can cause lipoatrophy in some cases, particularly if it affects the skin.
- Psoriasis: Psoriasis is a skin condition that can cause localized lipoatrophy in some cases, particularly if it affects the face.
- Scleroderma: Scleroderma is a group of autoimmune disorders that can cause localized lipoatrophy in some cases, particularly if it affects the skin.
- Dermatomyositis: Dermatomyositis is an autoimmune disorder that can cause localized lipoatrophy in some cases, particularly if it affects the skin.
- Drug-induced lipoatrophy: Certain medications, such as antiretroviral drugs used to treat HIV, can cause localized lipoatrophy as a side effect.
- Radiation therapy: Radiation therapy used to treat cancer can cause localized lipoatrophy in some cases, particularly if it affects the skin.
- Cryolipolysis: Cryolipolysis is a cosmetic procedure that uses cold temperatures to freeze and destroy fat cells
Symptoms
Here is a list of symptoms that have been associated with semicircular lipoatrophy:
- Sunken cheeks
- Loss of subcutaneous fat in the cheek area
- Loss of subcutaneous fat in the limb area
- Sagging skin in the affected area
- Wrinkling and aging of the skin
- Sunken temples
- Thinning of the lips
- Loss of subcutaneous fat in the temple area
- Loss of subcutaneous fat in the periorbital area
- Loss of subcutaneous fat in the nasolabial fold area
- Loss of subcutaneous fat in the upper eyelid area
- Loss of subcutaneous fat in the lower eyelid area
- Loss of subcutaneous fat in the jawline area
- Loss of subcutaneous fat in the neck area
- Loss of subcutaneous fat in the décolletage area
- Loss of subcutaneous fat in the arms
- Loss of subcutaneous fat in the legs
- Loss of subcutaneous fat in the abdomen
- Loss of subcutaneous fat in the hips
- Loss of subcutaneous fat in the buttocks
- Loss of subcutaneous fat in the thighs
- Loss of subcutaneous fat in the calves
- Loss of subcutaneous fat in the ankles
- Loss of subcutaneous fat in the forearms
- Loss of subcutaneous fat in the hands
- Loss of subcutaneous fat in the feet
- Loss of subcutaneous fat in the fingers
- Loss of subcutaneous fat in the toes
- Changes in skin texture and elasticity
- Changes in skin color and pigmentation
It is important to note that the symptoms listed above may vary from person to person and may not be present in all cases of semicircular lipoatrophy. Additionally, some people may experience only mild symptoms, while others may experience more severe symptom
Diagnosis
Here are some of the diagnostic tests that may be used to help diagnose semicircular lipoatrophy:
- Physical examination: A physical examination by a doctor is often the first step in diagnosing semicircular lipoatrophy. The doctor will examine the face and look for signs of fat loss, such as sunken cheeks, hollow temples, and circles around the eyes.
- Medical history: The doctor may ask about the patient’s medical history, including any previous illnesses, treatments, or conditions that may have caused the fat loss.
- Blood tests: Blood tests may be ordered to rule out other conditions that may cause fat loss, such as anemia, hypothyroidism, or an autoimmune disorder.
- Skin biopsy: A skin biopsy may be performed to examine the affected tissue and to rule out other conditions that may cause similar symptoms, such as sarcoidosis.
- Magnetic resonance imaging (MRI): An MRI is a non-invasive imaging test that can provide detailed images of the soft tissues, including the fat, in the affected area. This test can help determine the extent and severity of the fat loss.
- Computerized tomography (CT) scan: A CT scan is a type of X-ray that provides detailed images of the bones and soft tissues. This test can help determine the extent and severity of the fat loss.
- Ultrasound: An ultrasound is a non-invasive test that uses high-frequency sound waves to produce images of the internal structures of the body. This test can help determine the extent and severity of the fat loss.
- Biopsy: A biopsy may be performed to examine the affected tissue and to rule out other conditions that may cause similar symptoms, such as sarcoidosis.
- Skin prick test: A skin prick test may be performed to check for an allergic reaction to certain substances that may be causing fat loss.
- Patch test: A patch test may be performed to check for an allergic reaction to certain substances that may be causing fat loss.
- Intradermal test: An intradermal test may be performed to check for an allergic reaction to certain substances that may be causing fat loss.
- Allergy testing: Allergy testing may be performed to check for an allergy to certain substances that may be causing fat loss.
- Food allergy testing: Food allergy testing may be performed to check for an allergy to certain foods that may be causing fat loss.
- Endocrine testing: Endocrine testing may be performed to check for hormonal imbalances that may be causing fat loss.
- Thyroid function tests: Thyroid function tests may be performed to check for hypothyroidism, a condition in which the thyroid gland does not produce enough hormones.
- Adrenal function tests: Adrenal function tests may be performed to check for adrenal gland disorders, which may cause fat loss.
- Pituitary function tests: Pituitary function tests may be performed to check for pituitary gland disorders, which may cause fat loss.
- Diabetes testing: Diabetes testing may be performed to check for diabetes,
Treatment
The following are treatments for semicircular lipoatrophy:
- Topical retinoids: Topical retinoids, such as tretinoin and adapalene, can help increase collagen production and improve skin texture.
- Topical corticosteroids: Topical corticosteroids can help reduce inflammation and improve the appearance of skin.
- Topical growth factors: Topical growth factors, such as insulin-like growth factor-1 (IGF-1), can help stimulate collagen production and improve skin elasticity.
- Platelet-rich plasma (PRP) therapy: PRP therapy involves injecting a patient’s own blood plasma into the affected area to stimulate collagen production and improve skin texture.
- Laser therapy: Laser therapy, such as fractional laser resurfacing, can help improve skin texture and stimulate collagen production.
- Micro-needling: Micro-needling involves using tiny needles to create micro-injuries in the skin, which can stimulate collagen production and improve skin texture.
- Radiofrequency therapy: Radiofrequency therapy can help improve skin elasticity and reduce the appearance of fine lines and wrinkles.
- Chemical peels: Chemical peels can help improve skin texture by removing the top layer of dead skin cells.
- Microdermabrasion: Microdermabrasion can help improve skin texture by removing the top layer of dead skin cells.
- Intense pulsed light (IPL) therapy: IPL therapy can help improve skin texture and reduce the appearance of fine lines and wrinkles.
- Fat grafting: Fat grafting involves removing fat from one area of the body and injecting it into the affected area to improve skin texture and reduce the appearance of fat loss.
- Hyaluronic acid fillers: Hyaluronic acid fillers can help improve skin texture and reduce the appearance of fine lines and wrinkles.
- Collagen fillers: Collagen fillers can help improve skin texture and reduce the appearance of fine lines and wrinkles.
- Sculptra: Sculptra is a non-surgical filler that can help improve skin texture and reduce the appearance of fine lines and wrinkles.
- Botox: Botox can help reduce the appearance of fine lines and wrinkles.
- Dysport: Dysport is a similar treatment to Botox that can help reduce the appearance of fine lines and wrinkles.
- Xeomin: Xeomin is a similar treatment to Botox and Dysport that can help reduce the appearance of fine lines and wrinkles.
- Dermal fillers: Dermal fillers can help improve skin texture and reduce the appearance of fine lines and wrinkles.
- Liposuction: Liposuction can help remove excess fat from the affected area and improve skin texture.
- Tummy tuck: A tummy tuck can help remove excess fat from the affected area and improve skin texture.
- Thigh lift: A thigh lift can help remove excess fat from the affected area and improve skin texture.
References
