Lipodystrophy is a change in the subcutaneous fat tissue or the fatty tissue that coats the organs. It is divided into two forms, the shrinkage of fat tissue and the increase of fat deposits.
What is lipodystrophy?
Atrophy of fatty tissue is called lipoatrophy and occurs predominantly on the face, arms and legs, while an increase in subcutaneous fatty tissue – lipohypertrophy – tends to occur on the trunk and neck. Both types are metabolic disorders that regress depending on the cause, but can also be permanent. The disease itself rarely has serious consequences; however, most affected individuals suffer greatly psychologically from their altered appearance and, in addition, those affected often suffer from certain metabolic disorders.
Causes
The causes of lipodystrophy can be very diverse and science is far from knowing all the triggers. One of the known causes is insulin injections. If diabetics frequently inject themselves in the same region of the body and, in addition, in the same place, the effect of the insulin can lead to increased formation of fatty tissue at this location. Large bumps of fatty tissue then form on the abdomen, for example. This not only looks very unattractive, but also leads to another health problem. The injected insulin is increasingly poorly absorbed by the body. Another trigger of lipodystrophy is AIDS or HIV treatment. Here the causes are not yet completely clear. However, researchers assume that it is due to anti-HIV drugs, among other things. HIV-infected people are given special drugs to prevent the onset of the disease, and these highly effective drugs very likely trigger fat wasting in the facial area and on the legs, a so-called bull neck, and fat accumulation in the abdominal area. Data on how many patients are affected vary widely. Recent studies suggest that between 5 and 50 percent of all people treated with anti-retroviral drugs experience these side effects. But other factors could also play a role. Research is still in the early stages in this area. There are also some genetic lipodystrophies. These include Dunningan syndrome and Köbberling syndrome. Both are rather rare inherited metabolic disorders. They result from gene mutations that disrupt laminin synthesis and tend to affect the lower body. By contrast, Barraquer-Simons syndrome, another gene mutation that is very rare and occurs in childhood, is not hereditary. Girls are increasingly affected. Here, too, there is a loss of subcutaneous fatty tissue in the face and trunk. Parry-Romberg syndrome is equally rare. It is characterized by a hemifacial deformity. Here, not only the subcutaneous fatty tissue is affected but often also the bones and muscles.
Symptoms, complaints, and signs
When someone suffers from lipodystrophy, the external symptoms do not become noticeable until a late stage. The disease also causes little discomfort at first, in addition to the cosmetic problems and the mental stress associated with it. In addition to the altered appearance, however, there is also a risk of various concomitant diseases. For example, patients with lipodystrophy are more likely than other people to develop diabetes, inflammation of the pancreas, kidney inflammation and certain metabolic diseases.
Diagnosis and disease progression
Bumps caused by insulin injections are, of course, easily recognized by the physician, and in HIV patients, looking for signs of lipodystrophy is certainly part of the treatment regimen. In all other cases, diagnosis is difficult and often the disease is not recognized immediately. The course of the disease also varies greatly depending on the cause. Lipodystrophy caused by insulin injection disappears by itself when the patient stops having a needle in the affected area. Doctors therefore strongly advise to keep changing the injection site. In HIV-positive patients with lipodystrophy, the course of the disease is more difficult to assess. On the one hand, it is not yet really clear which active ingredients in the drugs are responsible for the fat tissue disorder, or whether there are other factors. On the other hand, the drugs cannot simply be dispensed with because they can be used to prevent the onset of AIDS.In the forms of lipodystrophy caused by gene mutations, the course of the disease also cannot be predicted.
Complications
In most cases, lipodystrophy leads primarily to emotional and psychological stress and discomfort. In this context, those affected are usually dissatisfied with their appearance and suffer from reduced self-esteem or inferiority complexes in the process. Furthermore, psychological complaints or even depression can develop and thus significantly reduce the patient’s quality of life. Lipodystrophy also leads to an increased risk of diabetes or inflammation of the pancreas. These can also occur in the kidneys. In the worst case, these can lead to complete renal failure and thus death. Patients are then dependent on dialysis or a donor organ to continue to survive. Likewise, lipodystrophy can cause various metabolic disorders and thus limit the daily life of the affected person. Treatment of lipodystrophy can take place with the help of medications. Likewise, the symptoms can be alleviated with the help of liposuction. Complications usually do not occur. Also the life expectancy of the patient is not changed due to lipodystrophy in most cases. Furthermore, surgical procedures can also be performed to limit the symptoms.
When should you see a doctor?
When changes in subcutaneous fat are noticed, medical advice is needed. Lipodystrophy is not a serious condition, but diagnosis and treatment are still necessary. People who notice unusual changes in the skin or suddenly suffer from physical discomfort should at best inform their family doctor directly. The physician can determine a disturbance in the formation of fat and refer the patient to a nutritionist, who will work out a suitable diet together with the patient. Accompanying this, the help of a therapist is often necessary, especially in the case of severely pronounced lipodystrophy. Thus, the disease is a great burden for most of those affected. Within the framework of therapeutic measures, the disease can be worked through and suitable measures can be worked out to restore the former well-being. People who have had the disease from birth must be closely monitored. Medication and diet must be regularly adjusted to the current state of health of the affected person to ensure an optimal course. Affected persons should consult their family doctor or an internist. In the case of physical complaints, an orthopedist should also be consulted.
Treatment and therapy
As outlined above, there is currently no way to cure lipodystrophy. There are, of course, very effective medications against the secondary diseases that often result from the disease, such as insulin resistance, impaired glucose tolerance, lipid metabolism disorders, and inflammation of the pancreas and kidneys. Because the fat deposits present in the neck, abdomen and chest areas in lipohypertrophy are not only unhealthy but often also very disturbing cosmetically, liposuction is also a treatment option in some cases. However, its sustainability is very questionable and it is also not paid by health insurance companies. If subcutaneous fat is missing, especially in the facial area, there is now the possibility of injecting filler substances. Depending on the material, these offer a shelf life of about twelve months. This method is also not covered by health insurance and should only be performed by experienced specialists. This is the only way to achieve satisfactory cosmetic results and minimize possible side effects. In Parry-Romberg syndrome, plastic surgery is performed due to the severity of the damage and the involvement of the bone substance.
Outlook and prognosis
The prognosis of lipodystrophy is tied to the causative disorder. The disorder of lipid metabolism may be genetic. In these cases, recovery is not a given. If there is a chronic underlying disease, this also does not lead to permanent freedom from symptoms. In order to change the fatty tissue, in this case the existing disease must be cured. Only then would a regression of lipodystrophy be conceivable. In the case of HIV infection, there is also no prospect of a cure.Nevertheless, in the case of chronic disease progression, there are good treatment methods to achieve relief from the symptoms. Although no cure will take place, there are rarely serious consequences. Mostly, these are concentrated in psychological after-effects, since a state of emotional stress occurs due to the optical changes. In very rare cases it can be observed that the metabolic disorder leads to a serious secondary disease. Nevertheless, an unfavorable course of the disease can lead to diabetes as well as renal insufficiency. The latter can lead to a fatal course of the disease if left untreated. Patients of lipodystrophy are provided with medication in a long-term therapy. In addition, liposuction can be initiated. This procedure is associated with risks and side effects. Nevertheless, it is a routine procedure that rarely causes complications. In many cases, the affected person learns to cope well with the disease in everyday life.
Prevention
There are no preventive measures against the development of lipodystrophy.
Aftercare
Because lipodystrophy is a serious disease that cannot cure itself, aftercare focuses on managing the disease well, both physically and mentally. In most cases, those affected by lipodystrophy suffer from diabetes, which requires regular check-ups with the attending physician. Due to the mental strain associated with the disease, those affected sometimes develop depression or moodiness. This can also occur in parents or relatives. The further course depends on the individual condition of the person affected and cannot be predicted in general. In many cases, however, the life expectancy of the affected person is significantly limited by this disease.
What you can do yourself
Since lipodystrophy cannot be cured so far, self-help measures focus on alleviating the symptoms. Early liposuction, accompanied by dietary changes, can reduce physical discomfort and cosmetic blemishes. In less severe cases, athletic measures, especially endurance sports such as jogging or swimming, also help. Alternatively, fat deposits can be reduced by heat treatment, which can be supported by targeted massages at home. If the aesthetic blemishes represent a considerable burden for the affected person, therapeutic counseling is also advisable. The affected person should contact his or her family doctor for this, as it is often possible for the costs to be covered by the health insurance fund. In the long term, however, the cosmetic restrictions must be accepted. The fat deposits in the face and neck in particular can return again and again and thus represent a chronic problem for which no satisfactory treatment exists to date. Nevertheless, close medical monitoring is important, as lipodystrophy carries an increased risk of diabetes, inflammation of the pancreas and other diseases. To avoid complications, patients should seek medical attention if they experience unusual symptoms.