|SPOT THE DIAGNOSIS
|Year : 2021 | Volume
| Issue : 2 | Page : 126-127
Asymptomatic unilateral gluteal skin depression with depigmentation
Anup Kumar Tiwary1, Varun Khullar2
1 Assistant Professor, Department of Dermatology, Venereology and Leprosy, Subharti Medical College and Hospital, Meerut, Uttar Pradesh, India
2 Senior Resident, Mulayam Singh Yadav Medical College and Hospital, Meerut, Uttar Pradesh, India
|Date of Submission||24-Jun-2020|
|Date of Decision||30-Jan-2021|
|Date of Acceptance||14-Mar-2021|
|Date of Web Publication||22-Jul-2021|
Dr. Anup Kumar Tiwary
Department of Dermatology, Venereology and Leprosy, Subharti Medical College and Hospital, Jeevan Ashray Apartment, C 58/08, Sector 62, Noida, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tiwary AK, Khullar V. Asymptomatic unilateral gluteal skin depression with depigmentation. Pigment Int 2021;8:126-7
A 2-year-old male child presented with asymptomatic, skin depression at right gluteal region for past 4 months. It started as mild cutaneous atrophy which gradually progressed to a markedly depressed lesion of about 2.5 cm in diameter. On local cutaneous examination, it was seen as single, well-defined, annular, about 1 cm deep gluteal depression with depigmentation of overlying skin [Figure 1]A and B. There were no visible signs of inflammation or scarring and skin was not indurated on palpation. No history of trauma, infection, or local intramuscular or subcutaneous injection (not even vaccines) at the affected site was found. There was no known personal or familial history of autoimmune connective tissue diseases and lipodystrophic syndromes. Routine hematological parameters and antinuclear antibody titer were within normal limits. Rapid test for HIV was also nonreactive. Histopathology revealed normal epidermis, sparse lymphohistiocytic infiltrates in deep dermis and fat layer, and diminished fat lobules.
|Figure 1 Well-defined, annular, gluteal skin atrophy with overlying depigmentation: (A) lateral view and (B) dorsal view|
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| Diagnosis|| |
Idiopathic localized involutional lipoatrophy
Idiopathic localized involutional lipoatrophy (ILIL) is an uncommon entity which was first described by Dahl et al. in 1996. It characteristically presents with asymptomatic, unilateral, localized skin depression due to focal loss of subcutaneous fat. Buttocks are the most commonly involved site followed by arms and thighs. Children and young females are mainly affected. The skin is mostly depigmented with no induration.
Its pathogenesis is not well understood. However, localized loss of fat has been attributed to the activated macrophages followed by the release of many cytokines such as fibroblast growth factor 2, platelet-derived growth factor, interleukin-1, tumor necrosis factor-α, and transforming growth factor-β. Histopathology reveals normal or atrophic epidermis, no or only few mononuclear inflammatory cells in deep dermis and subcutis, and shrunk fat lobules. Macrophages are CD-68 positive on immunohistochemistry. Most of the cases resolve spontaneously in few months or sometimes years.
Before diagnosing as ILIL, one should always rule out familial lipodystrophic syndrome, morphea, lupus profundus, antiretroviral drugs, and local triggering factors such as trauma, abscess, and intramuscular/subcutaneous injections (steroids, vaccines, insulin, antibiotics, iron, methotrexate, glatiramer, etc.). Usually, no treatment is required but steroids, tacrolimus, and hydroxychloroquine can also be tried to halt its progression.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Dahl PR, Zalla MJ, Winkelmann RK. Localized involutional lipoatrophy: a clinicopathologic study of 16 patients. J Am Acad Dermatol 1996;35:523-8.
Sharma RK, Gupta M, Negi L. Idiopathic localized involutional lipoatrophy: a retrospective study of 12 cases. Indian Dermatol Online J 2019;10:149-52.
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Tersigni C, Caporalini C, Buccoliero AM, Coronella G, de Martino M, Bassi A. Bilateral idiopathic localized involutional lipoatrophy in a child. Arch Dis Child 2019;104:774.