Lipoatrophy:
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Lipodystrophy (Lipoatrophy):

This usually refers to a loss of fat from the subcutaneous fat layer; subcutaneous fat is found immediately underneath the skin; a loss of subcutaneous fat leads to an increased definition of the muscle and bone structures underneath and presents itself as one or more depressions in the skin; if all, or most, of the underlying muscle and bone structures are affected, it is called Panatrophy.

Congenital And Acquired Lipodystrophy:

Lipodystrophy may be Congenital, which means the tendency to lose fat is present at birth, or it can be Acquired, which means the loss of fat occurs later in life; Lipodystrophy can affect all of the body, which is known as Generalised Lipodystrophy, or just parts of the body, which is known as Partial Lipodystrophy.

Acquired Lipodystrophy is the most common form of Lipodystrophy and is caused by:

1 - Steroid Injections, where a dent due to localised fat loss may appear at the site of the injections; this can be avoided by simply making sure that the injection is within the muscle tissue and not in the subcutaneous fat.
2 - Insulin Injections, where a dent due to localised fat loss may appear at the site of regular injections; this can be avoided by simply making sure that the injections are made in several sites, rather than just one or two.
3 - Other Injections of Penicillin, Iron, Growth Hormone, Vaccines and even the use of Acupuncture needles, where a dent due to localised fat loss may appear at the site of regular injections; these can be avoided by obtaining and following advice from your healthcare team.


N.B. A similar problem known as Lipohypertrophy is caused by repeatedly injecting Insulin into the same small area, resulting in a build up of lumps under the skin, rather than a loss of fat; this can result in an erratic absorption of insulin and can be unsightly.

Panniculitis:

This is a term used for inflammation of subcutaneous fat; it is sometimes followed by a permanent loss of fat; this type of Fat atrophy is particularly likely in Lupus Panniculitis 'Lupus Profundus' and some forms of Morphoea, which is a rare condition also known as Localized Scleroderma and is characterised by patches of red or purple skin that appear mainly on the torso, arms and legs.

Progressive Hemifacial Atrophy 'Parry-Romberg Syndrome':

This is characterised by a thinning of skin, fatty tissue and underlying bony structures of one side of the face; onset is usually during childhood and the cause is unknown.

Generalised Acquired Lipodystrophies are rare and they include:

Generalised Lipodystrophy known as the 'Lawrence Syndrome' is a rare disorder with a loss of fat during childhood and adolescence; females are affected more often than males; it may occur following infections such as chicken pox, measles and whooping cough; it is often associated with the elevation of blood cholesterol and Diabetes.

Partial Lipodystrophy known as the 'Barraquer-Simons Syndrome' usually occurs around 10 years of age after a viral illness; fat is lost from the face and trunk, but the legs and hips are spared; fat may accumulate in the legs and hips in women; females are affected three times more often than males; one third of patients also develop kidney disease; it is also associated with auto immune disorders including Systemic Lupus Erythematosus, Hypothyroidism and Rheumatoid Arthritis.

Lipodystrophy is also associated with The Human Immunodeficiency Virus (HIV) and is brought on by the long term treatment of antiretroviral drugs; the exact mechanism is unknown, but fat is lost from the face, arms, legs and buttocks; fat may accumulate on the neck and upper back.

Congenital Lipodystrophy can be generalised or partial and like many cases of Acquired Lipodystrophy, the cause is unknown; though, recent scientific advances have identified some genetic abnormalities.

Generalised Congenital Lipodystrophy known as the 'Berardinelli-Seip Syndrome' is a rare disorder with gene mutations of the Seipin or AGPAT2 gene; it is characterised by high levels of Insulin (due to Insulin Resistance) and high levels of blood fats; it results in gigantism (Acromegaly), enlarged liver and kidneys, Pancreatitis, Acanthosis Nigricans and increased body hair (Hypertrichosis), as well as a generalised loss of body fat.

Partial Congenital Lipodystrophy is associated with the metabolic Syndrome X and includes Hypertension, Insulin Resistance, Diabetes and Severe Hypertriglyceridemia resulting in Pancreatitis and Premature Coronary Artery Disease; sometimes a partial loss of fat results in other areas of fat enlarging to compensate; it spares the face and is inherited as an Autosomal Dominant Disorder, it is likely that half of the children of an affected individual will also be affected.

There are two subtypes, Type 1 is known as the 'Kobberling Syndrome' and results in a fat loss from the extremities and Central Obesity; so far it has only affected females; Type 2 is known as the 'Dunnigan Syndrome' and results in a fat loss from the extremities, abdomen and thorax; this is due to a mutation of the Lamin A/C gene or PPAR gamma gene, which is part of the nuclear membrane within the cell; mutations in this gene can result in a variety of other rare diseases including Muscular Dystrophy, Cardiomyopathy, Neuropathy and Progeria and are collectively termed Laminopathies.

Treatments for these conditions depends on the cause of the Lipodystrophy and can include the moving of fat from one part of the body to another using flaps and grafts, injectable filers and implants.

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