Acquired facial atrophy: A neglected clinical sign of POEMS syndrome

Abstract

I read with great interest the review on POEMS syndrome by Angela Dispenzieri [1]. As indicated by the author, skin lesions are frequent in this syndrome, some characteristic, and considered as minor criteria of POEMS syndrome. These include hyperpigmentation, hypertrichosis, and glomeruloid hemangioma, requiring a whole skin examination. However, the author does not mention acquired facial atrophy observed in more than half of patients in a recent dermatologic series including 21 patients conducted at our institution [2]. This clinical manifestation is similar to the lipoatrophy observed in HIV-infected patients under highly active antiretroviral therapy with protease inhibitors and nucleoside reverse transcriptase inhibitors as a part of the metabolic or lipodystrophy syndrome [3], or in patients with autoimmune diseases and alternate complement pathway abnormalities [4], including lupus panniculitis [5]. In our institution, we consider that POEMS syndrome should be evoked in patients not under antiretroviral treatment presenting with acquired facial lipoatrophy not preceded by a deep skin infiltration as observed in lupus panniculitis, when associated with polyradiculoneuropathy and monoclonal gammopathy. Claude Bachmeyer*, * Service de Médecine Interne, CHU Tenon (AP-HP), 4 rue de la Chine, 75020 Paris, France.