doi: 10.1111/j.1346-8138.2007.00295.x
Journal of Dermatology 2007; 34: 390 –393
CASE REPORT Blackwell Publishing Asia
Lipoatrophia semicircularis: A compressive lipoatrophy consecutive to persistent mechanical pressure María Isabel HERANE, Francisco URBINA, Emilio SUDY Cátedra de Dermatología, Escuela de Medicina, Universidad Andrés Bello, Santiago de Chile, Chile
ABSTRACT Lipoatrophia semicircularis is an infrequent condition characterized by semicircular depressions of the anterolateral aspects of the thighs. The origin of this peculiar variant of lipoatrophy is unknown, although repeated mechanical trauma on the affected thighs has been advocated in many cases. A 57-year-old woman presented with a 1-year history of two bilateral, parallel, symmetric, asymptomatic depressions on the anterolateral aspect of her thighs. The patient worked as a cashier, permanently seated and almost always wearing trousers. The localization of lesions and their linear artifactual appearance perfectly matched with the strangling folds formed by trousers while being sat. Echotomographic examination revealed a loss of the normal echogenic pattern in the subcutaneous tissue of the affected areas. We believe that the anatomical adipose constitution of women’s thighs predisposes that a persistent mechanical pressure induced by wearing trousers while being sat for long periods of time, originates a relative impaired circulation on a tenuous perfused tissue, and induces the development of lipoatrophia semicircularis. Key words: lipoatrophia semicircularis, lipoatrophy, localized lipoatrophy.
INTRODUCTION Lipoatrophia semicircularis is an infrequent condition characterized by semicircular depressions of the anterolateral aspects of the thighs. Almost exclusively described in healthy young women, it presents as a localized, often bilateral, symmetrical atrophy of the subcutaneous fat tissue. The lesions appear as horizontal, 2–4 cm in width, band-like cutaneous indentations with normal overlying skin. When more than one depression is present, lesions appear in a parallel arrangement.1 Multilocular and progressive lesions affecting the trunk and limbs have been described in an adipose patient.2 Until 1998, approximately 50 cases had been documented in the published work.3 Histopathological studies have been unspecific, showing inflammation of blood vessels, and a partial or complete loss of the fat replaced by newly formed collagen.4
The origin of this peculiar variant of lipoatrophy is unknown, although repeated mechanical trauma on the affected thighs has been advocated. We hypothesize a reasonable cause with respect to its origin.
CASE REPORT A 57-year-old woman presented with a 1-year history of two bilateral, parallel, symmetric, asymptomatic depressions on the anterolateral aspect of her thighs, which appeared as areas of cutaneous depressions, 3–4 cm wide, and 15 cm long (Fig. 1). The patient worked as cashier, permanently seated and almost always wearing trousers. Examined at her habitual position being sat at work, her trousers’ folds matched with the cutaneous bands (Fig. 2). Echotomographic examination of the affected areas showed symmetrical depressions of the subcutaneous tissue of both thighs (more accentuated
Correspondence: Francisco Urbina, M.D., Algeciras 583, Las Condes, Santiago de Chile, Chile. Email:
[email protected] Received 19 September 2006; accepted 29 November 2006.
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Figure 2. The more prominent folds of the patient’s trousers while being sat, perfectly matches the cutaneous bands observed on physical examination.
Figure 1. Two parallel and symmetrical depressions on the anterolateral aspect of the left thigh.
on the left side), with a loss of the normal echogenic pattern and compartmentalization. The lower lesion at the left side reached a minimum thickness of 8.1 mm, while the right one measured 10 mm (Fig. 3). Above and below the subcutaneous tissue recovered its normal pattern of 10.6 or 12 mm. The upper lesion showed similar characteristics. She has continued using trousers although she was advised to avoid them. The lesions have not disappeared.
DISCUSSION Different kinds of repetitive microtraumas have been advocated with respect to the origin of lipoatrophia semicircularis: pressure against chairs, ironing boards, wash-basins, and edges of tables.5 Mascaró and
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Figure 3. Echotomographic view of the lower lesion showing a depression of the subcutaneous tissue (* pointed by arrows in the affected zone, and normalization * at both extremes).
Ferrando6 were the first to suggest the possible role of wearing tight jeans in the origin of this condition: they described a 19-year-old woman with bilateral lesions at the point of maximum pressure of the jeans upon the thighs while being flexed on her knees. A year after, they described the same process in the sister of their patient, a women aged 23 who developed identical lesions after wearing the discarded jeans.7 In both cases, the lesions regressed after stopping the use of the jeans. We too believe that the use of trousers in women influences the development of lipoatrophia semicircularis, but especially when acting as a persistent mechanical
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pressure, that is, while being sat for long periods of time. It would be interesting to know if the apparition of this process coincides with the time in which women began to use trousers at work, because no descriptions of it were done before the 1970s.8 Repeated pressure on the anterolateral aspect of the thighs induced by trousers while being sat – as illustrated in our case – could be the most common and probable origin of semicircular lipoatrophy. The physical constitution of women, with gross adipose tissue at the thighs, could explain the predominance of this condition with respect to males in whom only a few cases have been described.9,10 Certain anatomical individual variations on the tenuous perfusion of the lateral aspect of the thighs could also influence the origin of the process9 and perhaps explain its low frequency of presentation. Repeated trauma on the thighs does not constitute a reasonable explanation for its development. One would expect a higher incidence of lipoatrophy in sports or other activities in which women (or men) are exposed to repeated traumas, which in fact does not occur. On the other hand, lipoatrophia semicircularis mostly develops at a particular zone of the thighs, while traumas could be obviously randomly distributed at other different levels of the lateral aspect of the thighs, sites where it has not been described. The constant localization of lesions and its linear artifactual appearance perfectly matches with the strangling fold formed by trousers (not necessarily tight ones) while sitting. The persistent mechanical pressure, acting on gross adipose tissue that is not profusely irrigated, determines a band of compression with a loss of superficial subcutaneous adipose tissue. Another possible cause of persistent mechanical pressure is the use of an elastic girdle, which has induced indentations on the thighs in at least two cases, at the zones in which the lower edge of the girdle contacted the thigh.11 Of considerable interest is the report of 18 cases of lipoatrophia semicircularis in the same company: 12 women and six men, all office workers, presented subcutaneous depressions on their thighs, mostly bilateral, which were attributed to repeated pressure against salient-edged furniture.5 The height of the depression measured from the floor was constant and it was the same as the height of the desks. However, no comments were made in relation to the
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use of trousers by desk workers. Similarly, other cases were described in 10 employees of a firm, 6 months after the chairs had been replaced.1 Pressure on the back of the thighs against the elevated front edge of the seat, together with direct pressure from the desk on the anterior thigh, was suggested as a possible origin. The women described did not wear tightly fitting jeans, but again it was not mentioned if they obligatorily or predominantly worn trousers as work clothing.1 In another report, seven cases were described in office workers of a company (six females and one male); the lesions were attributed to repeated trauma to the thighs caused by the edge of the desks; the thigh’s depressions were constantly situated at 74 cm from the floor, corresponding exactly to the height of the desks.12 No mention was made, however, with respect to the use of trousers at work in these patients. In summary, we believe that the anatomical adipose constitution of women’s thighs predisposes that a persistent mechanical pressure induced by wearing trousers while being sat for long periods of time, originates a relatively impaired circulation on tenuous perfused tissue, and induces the development of lipoatrophia semicircularis.
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8 Gschwandtner WR, Münzberger H. Ein Beitragzurband Formig circularen Atrophien del subcutanen Fettgewebes in Extremitätenbereich. Hautarzt 1974; 25: 222–227. 9 Bloch PH, Runne U. Lipoatrophia semicircularis beim Mann. Zusammentreffen von Arterienvarietät und Mikrotraumata als mögliche Krankheitsursache. Hautarzt 1978; 29: 270 –272.
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10 Egli ML, Ruffli TH. Lipoatrophia semi-circularis. Dermatologica 1978; 157: 300–303. 11 Ogino J, Saga K, Tamagawa M, Akutsu Y. Magnetic resonance imaging of semicircular lipoatrophy. Dermatology 2004; 209: 340–341. 12 Gruber PC, Fuller LC. Lipoatrophy semicircularis induced by trauma. Clin Exp Dermatol 2001; 26: 269–271.
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