Partial lipodystrophy in a patient with systemic lupus erythematosus

Area of Science:

• Dermatology
• Rheumatology
• Endocrinology

Background:

• Systemic lupus erythematosus (SLE) is a chronic autoimmune disease.
• Corticosteroid therapy, particularly prednisolone, is a common treatment for SLE.
• Facial lipodystrophy is a rare adverse effect associated with long-term corticosteroid use.

Observation:

• A 54-year-old woman with a history of SLE developed progressive partial lipodystrophy on the left side of her face.
• The lipodystrophy emerged during a period of inactive SLE and reduced prednisolone dosage.
• Lesions spread gradually without preceding skin symptoms, affecting the lower jaw, cheek, and forehead.

Findings:

• Histological examination revealed subcutaneous fat tissue loss with mild lymphocytic infiltration around dermal appendages and vessels.
• Increasing the prednisolone dose halted the progression of lipodystrophy.
• The observed lipodystrophy was clinically and histologically distinct from lipoatrophy associated with lupus profundus.

Implications:

• This case highlights a potential iatrogenic cause of facial lipodystrophy in SLE patients on corticosteroid therapy.
• Understanding the distinction between this form of lipodystrophy and lupus profundus is crucial for accurate diagnosis and management.
• Further research may be needed to elucidate the precise mechanisms and risk factors for corticosteroid-induced lipodystrophy in autoimmune diseases.