Lipoatrophic panniculitis: case report and review of the literature.
BACKGROUND
Lipoatrophic panniculitis (LP) is a rare disease of childhood characterized by eruption of tender erythematous nodules and plaques followed by circumferential bands of lipoatrophy often seen on the arms and legs. This condition has also been known as lipophagic panniculitis of childhood, annular atrophy of the ankles, and partial lipodystrophy.


METHODS
A previously healthy 8-year-old boy was evaluated for tender, raised plaques on the ankles, which progressed to circumferential atrophy of the distal lower extremities. Biopsy specimen analysis revealed a dense mixed infiltrate extending into the subcutaneous tissue as well as lipophages within the fatty lobules. A diagnosis of LP was made, and the patient began treatment with prednisone and hydroxychloroquine. Methotrexate was added later to the regimen as a steroid-sparing agent, and the dose was increased over the course of 3 months, by which time the cutaneous disease progression was nearly halted. However, the patient continued to have lower leg pain with bone changes demonstrated on magnetic resonance imaging.


CONCLUSIONS
We report this case and review of the literature to call attention to the clinical features of LP and its association with skeletal changes. Our patient's response to combination therapy is of interest and contributes to the limited literature about management of this disease.
Shen
Lisa Y
LY
Department of Dermatology, University of Wisconsin School of Medicine and Public Health, 1 S. Park Street, Madison, WI 53715, USA.
Edmonson
M Bruce
MB
Williams
Gary P
GP
Gottam
Chethana Chandrupatla
CC
Hinshaw
Molly A
MA
Teng
Joyce M
JM
D000842:Ankle; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D004359:Drug Therapy, Combination; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008060:Lipodystrophy / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D015434:Panniculitis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D011241:Prednisone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D011241:Prednisone; D008727:Methotrexate