Lipoatrophic panniculitis: a possible autoimmune inflammatory disease of fat. Report of three cases

Billings, J. K.

doi:10.1001/archderm.123.12.1662

Cited by 24 publications

(23 citation statements)

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“…2 The pathogenesis of lipoatrophy is speculative, but it is thought that lymphocyte-mediated damage to lipocytes leads to phagocytosis rather than cellular necrosis of the fat lobule, thereby resulting clinically in lipoatrophy. 3 The histopathologic findings of lipoatrophies may differ in early versus advanced cases, and the diagnosis may be chal-lenging. Case reports have shown that initial biopsies may indicate lymphocytic panniculitis, whereas later-stage biopsies can show atrophy of fat and mild focal inflammation.…”

Section: Discussionmentioning

confidence: 99%

Peripheral T‐cell lymphoma presenting as lipoatrophy and nodules

Yiannias¹,

DiCaudo²,

Maskin³

2006

Int J Dermatology

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Section: Discussionmentioning

confidence: 99%

Peripheral T‐cell lymphoma presenting as lipoatrophy and nodules

Yiannias¹,

DiCaudo²,

Maskin³

2006

Int J Dermatology

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“…The previously reported higher prevalence of LA in T1D than in type 2 diabetes and its apparent over-representation in female patients point to an immunological pathogenic process [4,5,6,7,8,9,10,11,28]. Hashimoto's thyroiditis and coeliac disease were more common in LA+ patients.…”

Section: Discussionmentioning

confidence: 95%

“…This is based on previously reported isolation of macrophages, lymphocytes, immunoglobulin (Ig) M, IgA, complement component 3, fibrinogen and fibrin from areas of LA and apparent reversal of the atrophic process upon local treatment with steroid [5,6,7,11,16,17,18,19,20,21,22,23]. In addition, there are case reports of increased circulating insulin antibody and IgG concentrations [6,18,20,22,24,25,26] where local cytokine release by macrophages may induce inflammation and thereby the dedifferentiation of adipocytes [11,19,27].…”

Section: Discussionmentioning

confidence: 99%

“…Given the apparently higher prevalence of LA in female patients with type 1 diabetes (T1D) [4,5,6,7,8,9,10,11], we hypothesised that Hashimoto's thyroiditis and coeliac disease would be more common in T1D patients with LA. Our exploratory objectives were to undertake a cross-sectional observational study of patients with LA and to determine the relationship between LA, gender, Hashimoto's thyroiditis and coeliac disease.…”

Section: Introductionmentioning

confidence: 99%

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Lipoatrophy Is Associated with an Increased Risk of Hashimoto's Thyroiditis and Coeliac Disease in Female Patients with Type 1 Diabetes

et al. 2013

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Background/Aims: Lipoatrophy (LA) is a rare, possibly under-recognised side effect of insulin treatment of unclear aetiology. The aim of this study was to describe the characteristics of patients with type 1 diabetes (T1D) who have LA and to explore the relationship between LA and other autoimmune diseases based on the hypothesis that additional autoimmune phenomena are more prevalent in T1D patients with LA. Methods: This was a cross-sectional observational study of T1D patients with LA in comparison to T1D patients without LA who are registered with the Diabetes Patienten-Verlaufsdokumentationssystem database of 241,650 patients in Germany and Austria. Results: Hashimoto's thyroiditis and coeliac disease were more prevalent in patients with LA (p < 0.001 for both). LA was associated with an increased risk of Hashimoto's thyroiditis and coeliac disease in female patients [odds ratio (OR) 2.5, p = 0.003, and OR 3.1, p = 0.02, respectively]. This relationship persisted after adjustment for current age, duration of diabetes and calendar year of treatment (OR 2.7, p = 0.002, and OR 3.5, p = 0.01, respectively). Conclusion: These findings support the hypothesis that an immune complex-mediated inflammatory process may be important in the development of LA.

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“…Peters and Winkelmann demonstrated that transitory lymphocytic panniculitis could represent the primary lesion by analyzing biopsy samples of early and late lesions [9]. Bilings et al reported on three child cases of lobular panniculitis that developed in a characteristic annular pattern, and resolved as lipodystrophy [10]. Tsuji et al examined a patient with localized lipodystrophy and showed lymphocytic inflammation within adipose tissues [11].…”

Section: Discussionmentioning

confidence: 99%

A Case of Insulin-induced Localized Lobular Panniculitis with Evidence for the Phagocytosis of Insulin by Histiocytes

et al. 2007

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Abstract. Insulin-induced localized lipoatrophy is a well-known localized side effect. Although an immune process has been suggested as its etiology, no definitive evidence has been reported to show that insulin is involved. Here, we report the first evidence for the phagocytosis of insulin by histiocytes as a very early stage of lipoatrophy, which was reproducible in two different lobular panniculitis tissues from a 71 year-old male patient. He had taken a subcutaneous insulin injection in his arms because of a sight disturbance. Since these subcutaneous tumors were likely due to inflammation by insulin, a biopsy sample was taken from the subcutaneous tumor of his right arm with his consent. The primary antibodies for insulin (1 : 200) and CD68 (1 : 50) were obtained from DAKO (guinea pig anti-insulin and mouse anti-human CD68). HE staining revealed the infiltration of mononuclear cells and histiocytes into the subcutaneous fat tissue, and some parts of this tissue had fibrosis with rich collagen fibers. These findings are consistent with a lobular panniculitis. Some histiocytes contained intracellular substances with a positive immunoreactivity to insulin. This activity was reduced when the anti-insulin antibody was preincubated with an excess amount of insulin antigen. The same substances were also positive to CD68. Thus, the phagocytosis of insulin by histiocytes appears to occur in this region. Therefore, the activation of subcutaneous macrophages by the complex of insulin and insulin antibodies may account for the initial autoimmune process.

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Lipoatrophic panniculitis: a possible autoimmune inflammatory disease of fat. Report of three cases

Cited by 24 publications

References 0 publications

Peripheral T‐cell lymphoma presenting as lipoatrophy and nodules

Peripheral T‐cell lymphoma presenting as lipoatrophy and nodules

Lipoatrophy Is Associated with an Increased Risk of Hashimoto's Thyroiditis and Coeliac Disease in Female Patients with Type 1 Diabetes

A Case of Insulin-induced Localized Lobular Panniculitis with Evidence for the Phagocytosis of Insulin by Histiocytes

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