Staphylococcus aureus suppression with sodium hypochlorite baths and intranasal mupirocin decreases clinical severity of atopic dermatitis

Abstract

Lipodystrophy (LD) is a rare disease characterized by the depletion of subcutaneous adipose tissue. It can be divided into congenital and acquired types. Acquired LD may have its onset in childhood. We describe two patients seen in our clinic within the last 10 years.Case 1: A 6-year-old male presented with a 3-week history of painful and symmetrical subcutaneous nodules over posterior knees extending progressively to thighs, legs, and ankles. He had type 1 diabetes mellitus treated with insulin for 3 years. Subcutaneous nodules evolved within few months into LD of lower extremities. Blood tests showed elevated sedimentation rate with slightly uncontrolled diabetes. Case 2: A 3-year-old female presented with otitis followed by subcutaneous nodules over the legs extending to the ankles, thighs, upper extremities, and face within 1 month and evolving into generalized LD with a protuberant abdomen. A decreased appetite with 3 kg weight loss was noted in the first weeks followed by a voracious appetite. Blood tests showed leukocytosis, elevated sedimentation rate, and C-reactive protein with normal fasting glucose. Abdominal ultrasound revealed hepatosplenomegaly. The rest of blood tests including liver and renal function tests, lipid profile, thyroid-stimulating hormone, and autoimmune antibodies were within normal range in the two cases. Skin biopsy of subcutaneous nodules showed panniculitis in both cases. Acquired LD may present from the first to the third decades of life. Onset is insidious over months to years, but can be quite rapid after an episode of infectious disease. In children, acquired LD is strongly associated with panniculitis, juvenile dermatomyositis and systemic lupus erythematosus. Localized forms of LD have been noted after local trauma, particularly subcutaneous injections of various medications including insulin. LD has been associated with insulin resistance, hepatomegaly, hyperlipidemia, acanthosis nigricans, and diabetes mellitus. Diabetes mellitus usually presented subsequent to the onset of acquired generalized LD but can appear simultaneously or precede the onset of LD. Monitoring for complications should be performed with yearly investigations consisting of lipid profile, liver function tests, fasting glucose, and glucose tolerance testing for patients with abnormal fasting glucose. When patients are symptomatic, have acanthosis nigricans, or hepatomegaly, they may require closer monitoring for development of complications. Steroids may alleviate LD to a certain degree.Commercial support: None identified.