Centrifugal lipodystrophy

Centrifugal abdominal lipodystrophy (CAL), also known as lipodystrophia centrifugalis abdominalis infantalis, is a rare pediatric form of lipodystrophy characterized by localized loss of subcutaneous fat in the abdominal region. It is primarily seen in children and tends to be self-limiting, with spontaneous resolution in many cases.

Pathophysiology

Centrifugal abdominal lipodystrophy is classified as a localized lipodystrophy disorder, where there is progressive loss of subcutaneous fat in a centrifugal pattern. The exact mechanism remains unclear, but proposed theories suggest:

• Inflammatory processes – Autoimmune-mediated destruction of adipose tissue.
• Metabolic dysfunction – Abnormal lipid metabolism leading to fat atrophy.
• Genetic predisposition – Familial clustering suggests a possible hereditary component.
• Viral or environmental triggers – Certain infections or environmental exposures may precipitate the disease.

Clinical Features

CAL typically presents in young children and is characterized by:

• Progressive fat loss – Starting around the umbilical region and spreading outward in a centrifugal pattern.
• Asymptomatic or mild discomfort – Most cases are painless, although some children report mild tenderness.
• Skin changes – The overlying skin remains intact, but mild hyperpigmentation or atrophic changes may be observed.
• Bilateral involvement – Though often asymmetric, both sides of the abdomen may be affected.

Unlike generalized lipodystrophy, CAL remains localized to the abdominal region and does not lead to significant metabolic complications.

Diagnosis

Diagnosis of centrifugal abdominal lipodystrophy is primarily clinical, based on characteristic fat loss patterns. Key diagnostic steps include:

• Detailed history and physical examination – Assessing the onset, progression, and distribution of fat loss.
• Histopathology (if biopsy is performed):
• Loss of adipocytes in the dermis and subcutaneous tissue.
• Minimal inflammatory infiltration.
• No evidence of necrosis or fibrosis.
• Imaging studies – Such as ultrasound or MRI to exclude other fat-atrophy syndromes.

Differential Diagnosis

Several conditions should be considered in the differential diagnosis of CAL, including:

• Localized lipodystrophy – Including post-inflammatory lipodystrophy and trauma-induced atrophy.
• Partial lipodystrophy – Conditions like Barraquer-Simons syndrome with fat loss in other regions.
• Lipoatrophy – A broader category of conditions leading to subcutaneous fat loss.
• Metabolic lipodystrophy syndromes – Such as congenital generalized lipodystrophy, which has systemic involvement.

Treatment and Management

Currently, there is no specific treatment for centrifugal abdominal lipodystrophy. Most cases resolve spontaneously over time without significant intervention. Management focuses on:

• Observation and reassurance – Parents should be informed about the self-limiting nature of the condition.
• Supportive care:
• Moisturizers for any skin changes.
• Sunscreen for hyperpigmented areas.
• Cosmetic options – In rare cases with persistent fat loss, options like autologous fat grafting may be considered for aesthetic concerns.

Prognosis

The prognosis for centrifugal abdominal lipodystrophy is excellent, with most cases resolving within months to a few years. Unlike other lipodystrophy syndromes, it does not lead to metabolic complications such as insulin resistance, diabetes mellitus, or dyslipidemia.

Related Pages

• Lipodystrophy
• Lipoatrophy
• Localized lipodystrophy
• Congenital generalized lipodystrophy
• Metabolic disorders