Lupus panniculitis-induced facial lipoatrophy: A case report and review of treatment strategies

Abstract

Lupus panniculitis is a rare form of cutaneous lupus erythematosus characterised by subcutaneous nodules or plaques which are usually localised on the scalp, face, arms, legs, trunk, and abdominal region. When the lesions have resolved, skin characteristically develops areas of lipoatrophy that present as depressions or skin retraction. Facial lipoatrophy is a challenging complication and can lead to major aesthetic sequelae that can severely decrease quality of life. Herein, we present a case of lupus panniculitis-induced facial lipoatrophy and summarise the available evidence regarding treatment strategies. A 28-year-old man presented with a 2-year history of a slowly evolving depression over the right cheek which was preceded by the development of a tender indurated plaque. Serologic testing revealed an antinuclear antibody titre of 1:320. Histologic analysis of a biopsy specimen from the right cheek revealed features consistent with lupus panniculitis. A diagnosis of lupus panniculitis-induced facial lipoatrophy was made. The patient is being managed with a combination of hydroxychloroquine and methotrexate and has been referred to plastic surgery for consideration of lipofilling. Nonabsorbable fillers and free flaps are two of the available treatment options. The lipofilling procedure appears to be safe and effective in achieving good aesthetic outcomes when performed in patients with stable disease. In addition, the short- and long-term absence of disease relapse and postsurgical complications are encouraging. Biodegradable fillers, such as synthetic hyaluronic acid, also have a good emerging safety profile as complications and hypersensitivity reactions are rare. It is important to provide effective therapeutic options for patients who develop lupus panniculitis-induced atrophy, especially if their lesions are cosmetically unacceptable. Given the condition's low prevalence, treatment strategies have not been extensively investigated. There is a need for additional high quality clinical trials to assist decisionmaking and guide best practice in the management of lupus panniculitis-induced atrophy.L6381498712022-06-08 <br />