Interactive Case Study - July 2021

Isolated Painless Left Hip Plaque ‎

Kelsey S. Hunt MD

Willis H Lyford MD‎

Nicholas F Logemann DO

A 36-year-old women presents with a 3-month history of new skin findings affecting her left hip. Clinical exam reveals a painless, well-circumscribed, atrophic-appearing plaque with a faint violaceous hue, which was most prominent at the periphery of the lesion (Figure 1). She denies any significant medical history or recent injury. A punch biopsy of the area showed the following histopathology (Figure 2 - 6). An additional punch biopsy of nearby normal skin was also performed (Figure 7 - 8).

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Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

What is the best diagnosis?

Localized lipodystrophy

Liposarcoma

Lupus panniculitis

Partial lipodystrophy

Traumatic panniculitis

Which of the following has been implicated as a cause of lipodystrophy?

Excessive exercise

Leg crossing

Physical trauma

Prolonged cold exposure

Silicone injections

Araújo-Vilar D, Santini F. Diagnosis and treatment of lipodystrophy: a step-by-step approach. J Endocrinol Invest. 2019;42(1):61-73. doi:10.1007/s40618-018-0887-z.
Patterson J. Section 5 The skin in systemic and miscellaneous diseases: Metabolic and storage diseases. Weedon’s Skin Pathology fifth edition, Elsevier Health Sciences, 2019. p. 579-80.
Tseng WW, Somaiah N, Lazar AJ, et al. Novel systemic therapies in advanced liposarcoma: a review of recent clinical trial results. Cancers (Basel). 2013;5(2):529-549. doi:10.3390/cancers5020529. Published online May 10, 2013.
Zhao YK, Wang F, Chen WN, et al. Lupus Panniculitis as an Initial Manifestation of Systemic Lupus Erythematosus: A Case Report. Medicine (Baltimore). 2016;95(16):e3429. doi:10.1097/MD.0000000000003429.
Oliveira J, Freitas P, Lau E, et al. Barraquer-Simons syndrome: a rare form of acquired lipodystrophy. BMC Res Notes. 2016;9:175. doi:10.1186/s13104-016-1975-9. Published online Mar 18, 2016.
Shellagi N, Rodrigues G. Traumatic panniculitis of the right thigh: a case report. Oman Med J. 2011;26(6):436-437. doi:10.5001/omj.2011.110.
Kalouche H, Whitfeld M. Leg crossers’ dimple: A form of localized lipoatrophy. Australasian Journal of Dermatology. 2006;47(4):253-257. doi: 10.1111/j.1440-0960.2006.00291.x.
Stinkens R, Brouwers B, Jocken J, et al. Exercise training-induced effects on the abdominal subcutaneous adipose tissue phenotype in humans with obesity. Journal of Applied Physiology. 2018; 125(5): 1585-1593. doi.org/10.1152/japplphysiol.00496.2018
Wollina U, Heinig B, Langner D, et al. Posttraumatic panniculitis – Case series and literature review. Global Dermatology. 2017; 4(3):1-3. doi: 10.15761/GOD.1000216.
Lipke MM, Cutlan JE, Smith AC. Cold Panniculitis: Delayed Onset in an Adult. Cutis. 2015; 95(1):21-24.
Bertin C, Abbas R, Andrieu V, et al. Illicit massive silicone injections always induce chronic and definitive silicone blood diffusion with dermatologic complications. Medicine (Baltimore). 2019;98(4):e14143. doi:10.1097/MD.0000000000014143.
Peters W, Fornasier V. Complications from injectable materials used for breast augmentation. Can J Plast Surg. 2009;17(3):89-96. doi:10.1177/229255030901700305.

Acknowledgements

Author Profiles

Kelsey S. Hunt

United States Navy Medical Corps‎

Kelsey S Hunt, MD, is a Transitional Year Intern at Naval Medical Center San Diego. She earned her medical degree from Tufts University School of Medicine in May 2020. She will be applying for Dermatology Residency and hopes to eventually complete her training in Dermatopathology.

Willis H Lyford

United States Navy Medical Corps‎

Willis H Lyford, MD, is a Dermatology Resident at Naval Medical Center San Diego. He completed his medical school training at Uniformed Services University of the Health Sciences.

Nicholas F Logemann

United States Navy Medical Corps‎

Nicholas F Logemann, DO, is a staff Dermatologist and Dermatopathologist at Naval Medical Center San Diego (NMCSD).

Question:

Interactive Case Study - July 2021

Acknowledgements

Author Profiles

Isolated Painless Left Hip Plaque ‎

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