Abstract
Physicians and patients have long been aware of skin lesions at the sites of insulin injections, referred to as lipodystrophy that can present as lipoatrophy (LA) or lipohypertrophy (LH). However, the reported prevalence of these different skin lesions varies widely, emphasizing the need for a correct identification method. In this short review we discuss LA and LH and also take into account other skin lesions, such as bruising, as well as different needle injuries, including those associated with the subcutaneous injection of pegvisomant (a drug aimed at counteracting the high levels of growth hormone associated with acromegaly), long-acting exenatide (a glucagon-like peptide-1 receptor agonist), and anti-tumor necrosis factor-alpha biologic agents (used against Crohn’s disease). In these latter cases specific studies are warranted to understand the pathophysiological background and possible prevention. However, the most common lesion is still insulin injection site-related LD, so a strong effort has to be made to avoid the confusion generated by previously misleading classifications which were barely able to reliably distinguish between LA and LH.
Highlights
Physicians and patients have long been aware of skin lesions at the sites of insulin injections, referred to as lipodystrophy that can present as lipoatrophy (LA) or lipohypertrophy (LH)
AMD is the Italian acronym for the Association of Diabetes Specialists and OSDI is the Italian acronym for Diabetes Care Health Professionals
All of these different types of skin lesions can be confounding, especially when no clear-cut differentiation can be made between well-defined lesions with different morphology and pathogenesis, such as insulin-related LH and LA
Summary
Lipodystrophy (LD), a disorder of adipose tissue, is one of the most common complications of subcutaneous insulin injections and may present as either lipohypertrophy (LH) or lipoatrophy (LA). The latter is defined as a Diabetes Ther (2016) 7:401–409 large, often deep, retracted scar on the skin that results from serious damage to subcutaneous fatty tissue [1]. LH is a thickened ‘rubbery’ tissue swelling which is mostly firm but may occasionally present as a soft lesion as well, and it is missed during a standard medical examination.
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