Semicircular lipoatrophia L90.8

Ferreira-Marques 1953; Gschwandtner/ Münzberger 1974

Recoverable ligamentous atrophy of the fatty tissue on the outside of the thighs in young women.

The exact causes have not yet been conclusively investigated. Chronic, repetitive, external traumatisation (e.g. regular propping up or leaning on table edges with the thighs) as well as local circulatory disturbances are discussed. Etiologically related is the so-called bra strap lipatrophy.

• Circumscript scleroderma: pale skin color, extensive induration, lilac ring; histological clarification with inflammatory infiltrates.
• Localized involutional lipoatrophy: mostly unilateral, rarely multilocular; skin atrophy (glucocorticoids, insulin) often superimposed in the area of injection sites.
• Anular lipoatrophy: possibly identical clinical picture.

The 49-year-old, obese saleswoman reported of an 8-month-old ("suddenly appeared") completely symptom-free, ligamentous depression on the extensor sides of both thighs. Trauma was not remembered, neither were injections in this area.

Findings: On both OS (at a height of about 80 cm), on the extensor side, a 3.5 cm wide, skin-coloured, semicircular, band-shaped indentation about 14 cm long, completely without irritation, without any induration. No change of the skin surface.

Histology: Normal fatty tissue without signs of inflammation.

Evaluation and course: By exact questioning it could be determined that the patient as a saleswoman, by forward rocking movement, induced a recurrent frontal traumatisation of the thighs. The resulting horizontal trauma pattern of the thighs was congruent to the edge of the counter. After this mechanism was uncovered and avoided, the surface depression "healed" completely within 8 months.

1. Ferreira-Marques J (1953) Lipoatrophia annularis. Arch dermatol syphilis 195: 479-491
2. Gschwandtner WR, Münzberger H (1974) Lipatrophia semicircularis. A contribution to ligamentous-circular atrophy of the subcutaneous fat tissue in the extremities. dermatologist 25: 222-227
3. Haas N et al (2002) Semicircular lipoatrophy in a child with systemic lupus erythematosus after subcutaneous injections with methotrexate. Pediatric dermatol 19: 432-435
4. Meiss F et al (2007) Band-like symmetrical horizontal depressions of both thighs. JDDG 5: 1141-1142
5. Nagore E et al (1998) Lipoatrophia semicircularis--a traumatic panniculitis: report of seven cases and review of the literature. J Am Acad Dermatol 39: 879-881
6. Röhrborn W et al (1988) Lipoatrophia semicircularis - on its pathogenesis. Act Dermatol 14: 94-95
7. Thiele B et al (1983) Multilocular progressive Lipoatrophia semicircularis. Dermatologist 34: 292-293