Semicircular Lipoatrophy: A Case Series With Follow-up of 76 Patients in Madrid and a Proposed Classification.

Abstract

BACKGROUND AND OBJECTIVE\nThe clinical presentations of semicircular lipoatrophy (SL) vary, and diagnostic criteria are unclear. Several etiopathogenic factors, including occupational environmental ones, have been suggested. We aimed to describe a cluster of cases of suspected SL that started to appear in May 2008 among employees of the city council of Madrid, Spain. We report the actions taken by the council s occupational health service and propose clinical categories with prognostic implications.\n\n\nMATERIAL AND METHODS\nObservational study of retrospectively identified patients that includes prospectively collected case data. Cases between 2008 and 2021 were identified for review by the city council s service for dermatology and prevention of sexually transmitted infections. Information on measures taken by the occupational health service and clinical data were analyzed for descriptive statistics and detection of clinical patterns to aid classification.\n\n\nRESULTS\nWe studied the cases of 75 women and 1 man, most of whom attended follow-up visits for a median of 37 months. Local symptoms were observed in just 14.5% of patients. The cases were classified into 4 groups: typical SL, unilateral SL, band-like lipoatrophy in the lower limbs, and nonspecific SL. Clinical outcomes were more often favorable in the first 2 groups, in which 76% of patients achieved total or partial improvement of lesions (vs. 25.8% in the last 2 groups). SL was negatively associated with the presence of hypertrophic subcutaneous adipose tissue (P < .001).\n\n\nCONCLUSIONS\nTypical SL, which can often be unilateral, generally has a satisfactory outcome. The clinical characteristics of this form distinguish it from other types of lipoatrophy. Measures taken by the occupational health service contributed to favorable outcomes. In this series, SL was not associated with marked subcutaneous adipose tissue hypertrophy in the thighs. Our proposed categories may help distinguish between cases of SL with a favorable prognosis and other SL types in which skin surface depressions form and are often persistent.