Membranous lipodystrophy: Secondary type

Abstract

BACKGROUND: A peculiar type of fat necrosis was noted in some patients with various skin diseases. OBJECTIVE: We attempted to develop a classification of membranous lipodystrophy combining the results of our study and a review of other articles. METHODS: Five cases of skin diseases with membranous lipodystrophy were studied and their clinical and histopathologic features were analyzed. Previous reports of similar findings were reviewed. RESULTS: Membranous lipodystrophic changes were noted in morphea profunda, lupus panniculitis, and factitial ulcer. Microcysts were formed by the coalescence of the destroyed fat cells and were lined by amorphous, eosinophilic material. Some of the linings had a crenelated appearance. Microgranules were found in the histiocytes and in the hyalinized collagen stroma. The linings and microgranules stained positively with periodic acid-Schiff, were resistant to diastase, and also stained with Sudan black B. CONCLUSION: We propose the use of the term secondary membranous lipodystrophy to describe the local subcutaneous membranous lipodystrophic change that occurs as a result of other skin diseases, in contrast to primary idiopathic membranous lipodystrophy, which occurs without any antecedent factors.