Journal of Clinical and Aesthetic Dermatology

MAY 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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40 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY May 2018 • Volume 11 • Number 5 C A S E S E R I E S excisions are required to remove asymmetrical lipoma mass, as well as a substantial amount of normal fat, which can cause excavating deformities and surface scarring and result in cosmetic residua (Figure 2). 3 Because of the scarring and deformation associated with lipoma excision, injection lipolysis has evolved as an alternative treatment, including injection of phosphatidyl choline, deoxycholate (a bile acid), and the combination of both phosphatidyl choline/sodium deoxycholate, ethanol, and other sclerosing solutions. 16–21 The main problem with these sclerosing agents is that, while these solutions cause lipolysis with necrosis and involution of fat, they can be extremely irritating and destructive to tissues and can injure local nerves, arteries, and veins and cause chronic neuropathy, thrombosis, and local vascular problems. 26 Corticosteroids have less potential for injury of local nerves and blood vessels, but they can also induce lipolysis and fat involution and thus have been used as a treatment of subcutaneous lipomas. 16 Redman et al 27 demonstrated that injection of the lipoma with 0.07mg of prednisolone a day in an intense regimen (5 out of 7 days per week for 4 weeks) resulted in a reduction in lipoma size by 50 percent. However, most lipomas recurred, requiring subsequent excision. 27 Triamcinolone acetonide is a more potent and insoluble corticosteroid than prednisolone and is notorious for causing cosmetic complications, including hypopigmentation, atrophy of the skin, and lipoatrophy (Figure 3). 7,28–33 Lamagna et al 34 used this usually negative effect for therapeutic reasons in a much more aggressive regimen using 40mg of triamcinolone acetonide in canine lipomas, which resulted in significant atrophy of the lipomas and excellent clinical responses without complication. In our study subjects, we also used the usually deleterious atrophic effect of triamcinolone acetonide to elicit a beneficial outcome—that is, lipoatrophy—to treat lipomas by single injection. However, unlike Lamagna et al, who studied this application in canines, we used this technique in humans. We achieved a 60-percent reduction in lipoma size and a 100-percent reduction in symptomatology associated with lipoma, with few serious adverse events in our patients, confirming and extending the therapeutic results of Lamagna et al (Table 1 and Figure 5). 34 The mechanisms behind lipoatrophy in a benign lipoma after a corticosteroid injection remain somewhat speculative. After FIGURE 4. Ultrasound image of a subcutaneous lipoma mass; needle and injected triamcinolone acetonide marked by long arrows; lipoma mass marked by short arrows FIGURE 5. A) Superficial lipoma mass before triamcinolone injection; B) at four months post-injection A B

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