Treatment of localized involutional lipoatrophy after local injection of corticosteroids into a keloidal scar with fat injection.

Sir:

It is reported that localized involutional lipoatrophy improves or completely heals naturally within 1 year in the majority of cases.[1] However, there are no signs of improvement in some cases, and surgical treatment is necessary for them. We treated localized involutional lipoatrophy after local injection of corticosteroids into a keloidal scar with autologous fat injection.

A 24-year-old woman presented with a keloidal scar on her left upper arm. We first performed surgical removal and postoperative 15-Gy-electron-beam irradiation to prevent recurrence. The postoperative scar was slightly raised and displayed redness 6 months after the excision of the keloidal scar. We then administered local intracutaneous corticosteroid (triamcinolone acetonide) injections to the proximal and distal sides of the scar once a month for 5 months. At month 7 after the last administration, she visited us with a 45 × 15 mm concave area present on the distal side of the scar (Fig. 1). Magnetic resonance imaging (MRI) revealed thinning of the fatty layer of the subcutaneous tissue in this region without inflammation of the surrounding tissues. Our diagnosis was localized involutional lipoatrophy caused by local injection of corticosteroids. Thus, we performed autologous fat injection 4 months after the diagnosis. Under local anesthesia, the fat injection was performed according to the method reported by Coleman.[2] Autologous fat was obtained from the lower abdomen, and a total of 5.5 cm3 of refined fatty tissue was injected into the concave area. MRI at 3 months after the fat injection revealed that the injected fatty tissue was not distinguishable from the circumambient subcutaneous tissue. One year after the fat injection, no concavities or pigmentation was detected on physical examination except for a raised red scar overlaying the injected fatty tissue (Fig. 2).

Fig. 1.

View obtained at month 7 after the last corticosteroid injection. A 45 × 15 mm concave area appeared on the distal side of the postoperative scar.

Fig. 2.

One year after the fat injection. A, A raised red scar overlays the injected fatty tissue. B, No concavities were detected in a physical examination.

According to Dahl et al[3] in 1996, local injection of corticosteroids or antibiotics was present in 62% of cases of localized involutional lipoatrophy. All of the patients except for one 5-year-old boy were young and female. From the above information, we diagnosed our patient with localized involutional lipoatrophy. In the present case, we performed fat injection at 4 months after diagnosis with localized involutional lipoatrophy. This is because there was severe lipoatrophy shown in the MRI, and the patient strongly wished to improve the condition.

Many plastic surgeons have reported the positive results of injected fat on surrounding tissues. For example, Rigotti et al[4] have successfully treated end-stage radiation dermatitis with fat injection. Although stem cells explain some of these effects, we do not yet have a full understanding of the mechanisms of such healing. In our case, a raised, red scar overlay appeared on the surface of the injected fatty tissue 1 year after the fat injection. We consider that it may have been caused by the injected fat. For the treatment of localized involutional lipoatrophy, we are able to obtain positive results using autologous fat injection in respect of improvement of the concavity, but we would also like to point out the possible risk of keloidal scars developing after the autologous fat injection.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the author.