201 Dermatol Sinica, June 2006

Lipoatrophia Semicircularis- A Case Report and Review of the Literature

Wang-Cheng Ko1 Tsen-Fang Tsai2 Chi-Ming Hung1

Lipoatrophia semicircularis is a rare condition manifested by semicircularly horizontal depressionson the anterolateral aspects of the thighs. Most of the patients are females. Previous literature has shownthat repeated external trauma is the most plausible explanation, though in some cases, no underlyingtraumatic mechanisms are found. We herein report a case of lipoatrophia semicircularis in a femalepatient who has noticed this condition for two months. The clinical history revealed repetitive pressureon her thighs during the work. Previous reports in the literature are reviewed. (Dermatol Sinica 24: 201-204 , 2006)

Key words: Lipoatrophia semicircularis, Repeated external trauma

(

24: 201-204, 2006)

From the Department of Dermatology, Show-Chwan Memorial Hospital,1 and Department of Dermatology, National TaiwanUniversity Hospital2

Accepted for publication: January 23, 2006Reprint requests: Tsen-Fang Tsai, M.D., Department of Dermatology, National Taiwan University Hospital, No. 7, Chung-ShanSouth Road, Taipei 100, TaiwanTEL: 886-2-23562141 ext. 5734 FAX: 886-2-23934177

Dermatol Sinica, Sep 2006 202

INTRODUCTIONLipoatrophia semicircularis is rare with

around 100 cases reported in the literature.1-12 Itmanifested as semicircular, horizontal, band-like depressions on the anterolateral aspects ofthe thighs. Most of the patients are women. Thecause is unknown, but pressure has been postu-lated to contribute to its etiology.1-12 We present-ed a new case of female patient who worked ina factory. Repeated trauma was identified as atrigger factor.

CASE REPORTA 39-year-old woman presented with a 2-

month history of an asymptomatic, lineardepression on the anterolateral aspect of leftthigh (Fig. 1, 2). The overlying skin was normal.

Fig. 1 Atrophic bands on anterolateral aspects of the thighs.

Fig. 2 Close observation of the semicircular, horizontaldepression on the anterolateral aspect of the left thigh.

Fig. 3 New vertical machining center.

Her past medical history was unremarkable.The patient did not receive injections of insulin,corticosteroids or acupuncture and she did notremember previous trauma to the lesion.

The patient worked in a small factory.Tracking back her history, she rememberedworking with a new vertical machining centersince six months ago (Fig. 3). While working,she had to lean forward pushing her thighagainst the edge of the machine. The location ofthe atrophic lesion coincided exactly with theheight of the machine edge (Fig. 4).

On examination, the lesion was approxi-mately 2 cm wide, flesh-colored band-likesemicircular depression located horizontally onthe anterolateral aspect of the left thigh withoutchange in consistency. The overlying skin was

Fig. 4 The lineal depression coincided with the edge of themachine.

203 Dermatol Sinica, Sep 2006

normal. No tenderness, swelling or inflammato-ry signs had preceded the lesion. On closeinspection, the right thigh showed a similardepression, but was much less discernible.Histopathology showed mild atrophy of epider-mis, normal dermis and some small- to medi-um-sized lipocytes with intervening hyaline tis-sue. (Fig. 5, 6).

DISCUSSIONLipoatrophia semicircularis is rare with

around 100 cases reported since it was firstdescribed in three patients by Gschwandtnerand Munzberger in 1974.1-12 This form of lipoat-rophy is characterized by band-like horizontaldepressions, measuring 2-4 cm in width, on theanterolateral aspects of the thighs. The overly-ing skin is usually normal. The lesions are usu-ally symmetrically located on both thighs, butunilateral cases have been reported. Most of thepatients are females in their twenties and thir-ties. The lesions tend to develop quickly in mostcases and are usually asymptomatic. Afteravoiding the trauma, the lesions resolve within2 weeks to 4 years.1, 3, 4, 6, 8, 9, 11

Since the condition is mild, most of the

patients refused to undergo biopsy. On micro-scopic examinations, some authors reported par-tial or complete loss of fat replaced by new col-lagen with no signs of inflammation, but othersdid not find consistent abnormalities.2-4, 13

Laboratory parameters in all cases were normal. The cause of lipoatrophia semicircularis

remains unknown. Many reports support themechanical explanation.1-12 Nagore et al. report-ed 7 cases of lipoatrophia semicircularis and thedetailed clinical history revealed precipitatingtrauma in all cases (e.g., knocking against theedge of a table, chair, laundry, and wearingtight-fitting jeans).3 Gruber and Fuller found 7cases in the same office and they also observedthat the site of indentations on the thighs in allcases were 74 cm from the floor, correspondingto the exact height of the desks in the office.1

They suggested that repeated trauma to the

Fig. 5 Mild atrophy of epidermis and normal dermis (H & E, x20)

Fig. 6A: Some small- to medium-sized lipocytes with interveninghyaline tissue. (H & E, x40) B: Higher power of image A.(H & E, x100)

A

B

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thighs by the sharp edge of the desks was themost likely explanation.1 De Groot identified 10cases of lipoatrophia semicircularis in a 300-employee firm.6 The author suggested that pres-sure on the backs of the thighs from the chair,together with direct pressure from the desk onthe anterior thighs were responsible for thelesions.6

In our case, the patient used to work withan old machine and there were no symptomsand signs before. Around 6 months ago, shebegan to work with the new machine which hadsharp edge. The lesion appeared on her leftthigh 4 months later. While working, she leanedher thighs against the edge of the machine. Theposition of the indentation on her left thigh cor-responded exactly to the height of the machineedge. This evidence supports that repeated trau-ma to the thigh by the sharp edge of themachine was the most likely cause in our case.

In conclusion, we suggested that repeatedminor trauma to the anterolateral thighs was themost possible explanation of semicircular lipoa-trophy. Since the condition is mild, mostpatients do not consult a dermatologist and thedisorder is unrecognized. The disease might bemore common than actually reported. Weemphasize on the careful history taking to iden-tify the possibility of trauma in the lipoatrophiasemicircularis.

REFERENCES1. Gruber PC, Fuller LC: Lipoatrophy semicircularis

induced by trauma. Clin Exp Dermatol 26: 269-271, 2001.

2. Ayala F, Lembo G, Ruggiero F, et al.: Lipoatrophiasemicircularis. Report of a case. Dermatologica170: 101-103, 1985.

3. Nagore E, Sanchez-Motilla JM, Rodriguez-SernaM, et al.: Lipoatrophia semicircularis - a traumaticpanniculitis: report of seven cases and review ofthe literature. J Am Acad Dermatol 39: 879-881,1998.

4. Rongioletti F, Rebora A: Annular and semicircularlipoatrophies. Report of three cases and review ofthe literature. J Am Acad Dermatol 20: 433-436,1989.

5. Hermans V, Hautekiet M, Haex B, et al.:Lipoatrophia semicircularis and the relation with

office work. Appl Ergon 30: 319-324, 1999. 6. De Groot AC: Is lipoatrophia semicircularis

induced by pressure? Br J Dermatol 131: 887-890,1994.

7. Karkavitsas C, Miller JA, Kirby JD: Semicircularlipoatrophy. Br J Dermatol 105: 591-593, 1981.

8. Mascaro JM, Ferrando J: Lipoatrophia semicircu-laris: The perils of wearing jeans? Int J Dermatol21: 138-139, 1982.

9. Hodak E, David M, Sandbank M: Semicircularlipoatrophy - a pressure-induced lipoatrophy? ClinExp Dermatol 15: 464-465, 1990.

10.Gschwandtner WR, Munzberger H: Lipoatrophiasemicircularis. Hautarzt 25: 222-227, 1974.

11.Gomez-Espejo C, Perez-Bernal A, Camacho-Martinez F: A new case of semicircular lipoatro-phy associated with repeated external microtrau-mas and review of the literature. J Eur AcadDermatol Venereol 19: 459-461, 2005.

12.Senecal S, Victor V, Choudat D, et al.: Semicircularlipoatrophy: 18 cases in the same company.Contact Dermatitis 42: 101-102, 2000.

13.Peters MS, Winkelmann RK: The histopathologyof localized lipoatrophy. Br J Dermatol 114: 27-36, 1986.