The Lipodystrophy is a change in the subcutaneous fatty tissue or the fatty tissue that surrounds the organs. A distinction is made between two forms, the loss of adipose tissue and the increase in fat deposits.
What is lipodystrophy?
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The depletion of fat tissue is called lipoatrophy and occurs predominantly on the face, arms and legs, while an increase in the subcutaneous fat tissue - the Lipohypertrophy - occurs more on the torso and neck. Both types are metabolic disorders which, depending on the cause, regress again, but can also be permanent.
The disease itself rarely has serious consequences, but most of those affected suffer psychologically from their changed appearance and they also often suffer from certain metabolic diseases.
causes
The causes of lipodystrophy can be very diverse and science does not yet know all the triggers. One of the known causes is insulin injections. If diabetics often put the syringe in the same area of the body and also in the same place, the action of the insulin can lead to increased formation of fatty tissue at this point.
Then, for example, large bumps made of fatty tissue develop on the stomach. Not only does it look very ugly, it also leads to another health problem. The injected insulin is absorbed less and less by the body. Another cause of lipodystrophy is AIDS, or HIV treatment. Here the causes are not yet completely clear.
However, research assumes that it is, among other things, due to anti-HIV drugs. HIV-infected people are given special drugs that are supposed to prevent the onset of the disease and these highly effective drugs are very likely to trigger fat depletion in the face and legs, a so-called bull neck and fat accumulation in the stomach area.
The information about how many patients are affected varies widely. Recent studies suggest that between 5 and 50 percent of all people treated with anti-retroviral drugs get these side effects. But other factors could also play a role. Research in this area is still in its infancy.
There are also some genetic lipodystrophies. These include Dunningan's syndrome and Köbberling's syndrome. Both are rather rare hereditary metabolic diseases. They arise through gene mutations that disrupt laminin synthesis and tend to affect the lower part of the body. On the other hand, 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 on the face and trunk. Parry-Romberg syndrome is just as rare. It is characterized by a half-sided curvature of the face. Not only the subcutaneous fatty tissue is affected here, but also the bones and muscles.
Symptoms, ailments & signs
When someone has lipodystrophy, the outward symptoms do not become apparent until a later stage. In addition to the cosmetic problems and the associated emotional stress, the disease initially hardly causes any discomfort.
In addition to the changed appearance, there is also the risk of various concomitant diseases. Patients with lipodystrophy are more likely than other people to develop diabetes, inflammation of the pancreas, kidney infections and certain metabolic diseases.
Diagnosis & course of disease
The doctor can of course easily recognize bumps caused by insulin injections 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 is also very different depending on the cause.
Lipodystrophy caused by the insulin injection disappears by itself if the patient no longer inserts a needle in the affected area. Doctors therefore urgently recommend changing the injection point again and again. 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 medication are responsible for the adipose tissue disorder, or whether there are other factors. On the other hand, one cannot simply do without the drugs because they can prevent the outbreak of AIDS. In the case of the forms of lipodystrophy caused by gene mutations, the course of the disease cannot be predicted either.
Complications
In most cases, lipodystrophy leads mainly to emotional and psychological stress and complaints. Those affected are usually dissatisfied with their appearance and suffer from reduced self-esteem or from inferiority complexes. Psychological complaints or even depression can continue to 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 kidney failure and thus death. The patients then have to rely on dialysis or a donor organ to continue to survive. Lipodystrophy can also cause various metabolic diseases and thus limit the everyday life of the person affected.
Treatment of lipodystrophy can take place with the help of drugs. The symptoms can also be alleviated with the help of liposuction. There are usually no complications. The life expectancy of the patient is also not changed in most cases due to lipodystrophy. Surgical interventions can also be carried out to limit the symptoms.
When should you go to the doctor?
If changes in the subcutaneous fatty tissue are noticed, medical advice is sought. Although lipodystrophy is not a serious condition, diagnosis and treatment are necessary. People who notice unusual changes in the skin or suddenly suffer from physical complaints should, at best, inform their doctor directly. The doctor can determine a disorder of fat formation and refer the patient to a nutritionist who works out a suitable diet together with the patient.
In addition, the help of a therapist is often necessary, especially in the case of very pronounced lipodystrophy. The disease is a great burden for most of those affected. As part of therapeutic measures, the disease can be dealt with and suitable measures can be developed to restore the previous well-being. People who are sick from birth must be closely monitored. The medication and diet must be regularly adjusted to the current state of health of the person concerned, so that an optimal course is guaranteed. Those affected should consult their family doctor or an internist. An orthopedic surgeon should also be consulted in the event of physical complaints.
Treatment & Therapy
As already shown, there is currently no way to cure lipodystrophy. There are of course very effective drugs 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 in the neck, stomach and chest area in lipohypertrophy are not only unhealthy, but often also very annoying cosmetically, liposuction is also a treatment option in some cases. However, its sustainability is very questionable and it is not paid for by the health insurance companies.
If there is a lack of subcutaneous fat, especially in the facial area, there is now the option of injecting filling substances. Depending on the material, these offer a shelf life of around twelve months. The method is also not covered by health insurance companies and should only be carried out by experienced specialists.
This is the only way to achieve satisfactory cosmetic results and minimize possible side effects. In Parry-Romberg syndrome, plastic-surgical interventions are carried out due to the severity of the damage and the involvement of the bone substance.
Outlook & forecast
The prognosis of lipodystrophy is tied to the causal disorder. The disorder of lipid metabolism can be genetic. In these cases there is no recovery. If there is a chronic underlying disease, this also does not lead to permanent freedom from symptoms. In addition to changes in the adipose tissue, the present disease must be cured in this case. Only then would a regression of lipodystrophy be conceivable.
With HIV infection there is also no prospect of a cure. Nevertheless, there are good treatment methods for chronic disease progression to alleviate the symptoms. While there will be no healing, there are seldom serious consequences. In most cases, these are concentrated on psychological sequelae, as the visual changes create a state of emotional stress. In very rare cases it can be observed that the metabolic disorder leads to a serious secondary disease. Nevertheless, if the disease progresses poorly, diabetes and kidney failure can occur. The latter can lead to a fatal course of the disease if left untreated.
Patients with lipodystrophy are provided with medication in long-term therapy. In addition, liposuction can be initiated. There are risks and side effects associated with this procedure. Nevertheless, it is a routine process that rarely causes complications. In many cases, the person affected learns how to deal with the disease in everyday life.
prevention
There are no preventive measures against the development of lipodystrophy.
Aftercare
Since lipodystrophy is a serious disease that cannot self-heal, follow-up care focuses on managing the disease well, both physically and mentally. In most cases, those affected suffer from diabetes due to lipodystrophy, which requires regular monitoring by the attending physician.
Due to the psychological stresses associated with the illness, those affected sometimes develop depression or moods. This can also occur with parents or relatives. The further course depends on the individual condition of the person concerned and cannot be generally predicted. In many cases, however, the life expectancy of the person affected is significantly reduced by this disease.
You can do that yourself
Since lipodystrophy is currently not curable, self-help measures focus on alleviating the symptoms. Early liposuction, accompanied by a change in diet, can reduce physical complaints and cosmetic blemishes. In less severe cases, athletic measures, especially endurance sports such as jogging or swimming, also help. Alternatively, the fat deposits can be reduced by a heat treatment, which can be supported by targeted massages at home.
If the aesthetic flaws represent a significant burden for the person concerned, therapeutic advice is also useful. The person concerned should contact their family doctor for this, as the health insurance company can often cover the costs. In the long term, however, the cosmetic restrictions must be accepted. Above all, the fat deposits on the face and neck can return again and again and thus represent a chronic problem for which there is currently no satisfactory treatment.
However, close medical supervision is important because lipodystrophy increases the risk of diabetes, pancreatitis, and other diseases. To avoid complications, patients should see a doctor if they have unusual symptoms.
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