title: DPT vaccine-induced lipoatrophy: an observational study.
abstract: BACKGROUND
  Diphtheria Pertussis Tetanus (DPT) vaccine is universally used in infants and children. It is generally safe and well tolerated. Local reactions such as erythema, induration, palpable nodules, and injection site abscess are well known. Injection site lipoatrophy has not been reported earlier.
  
  
  METHODS
  Retrospective review of all cases presenting with lipoatrophy developing at injection site following DPT administration between 2000-2005 in 3 hospitals in New Delhi, India was performed. In each case, the patients were extensively evaluated for other possible causes of lipoatrophy.
  
  
  RESULTS
  8 infants (2 boys & 6 girls), age range 4-12 months, had presented with injection site lipoatrophy following DPT vaccination. The duration between the last injection and lipoatrophy ranged from 4 to 8 weeks. All had been administered the vaccine in the buttock instead of the thigh, as generally recommended in infants. Majority (6/8) developed lipoatrophy after the second dose. No systemic causes were found.
  
  
  CONCLUSIONS
  DPT vaccine may, in rare instances, lead to injection site lipoatrophy. Inadvertent administration into the subcutaneous fat of the buttock may have been causative. Other possible mechanisms are discussed. Paramedics and general practitioners need to be educated to administer intramuscular vaccines in the thigh in infants and young children.
authors.affiliation: Department of Dermatology, Maulana Azad Medical College and Chacha Nehru Bal Chikitsalaya, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. kabir_sardana1@rediffmail.com
authors.forename: Kabir
authors.initials: K
authors.lastname: Sardana
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Garg
authors.forename: Premanshu
authors.initials: P
authors.lastname: Bhushan
authors.forename: Vineet
authors.initials: V
authors.lastname: Relhan
authors.forename: Suvasini
authors.initials: S
authors.lastname: Sharma
mesh_terms: D002081:Buttocks / Q000473:pathology; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007117:Immunization, Secondary / Q000009:adverse effects; D007223:Infant; D008060:Lipodystrophy / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D019370:Observation; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D050151:Subcutaneous Fat / Q000473:pathology*
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine