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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Five cases of progressive facial hemiatrophy (PFH) are reported. A nonindurated depression on normal-colored skin was observed in the cheeks of 3 subjects, and 2 patients showed indurated, pigmented atrophic lesions associated with linear scleroderma or generalized morphea. Lipoatrophy with mild subcutaneous fibrosis was observed histologically in the patients with nonindurated depressions. In contrast, the patients with indurated lesions exhibited a marked dermal fibrosis and the disappearance of appendices in the dermis. When compared with unaffected skin used as a control, collagen and glycosaminoglycan contents were not different in diseased areas. However, the dermatan sulfate/hyaluronic acid ratio was increased 1.5- to 3.2-fold in PFH patients regardless of their clinical and histological differences. These results suggest that both types of PFH may be based on a similar connective tissue disorder.
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PMID:Progressive facial hemiatrophy: report of five cases and biochemical analysis of connective tissue. 144 85

We present two Japanese cases of involutional lipoatrophy. The first case is that of a 30-year-old woman, who first appeared at our hospital complaining of a localized, well-demarcated depression, approximately 3 x 4 cm in size, normal to slightly erythematous in coloration, on the lateral side of the left upper arm (Fig. 1a). The condition was asymptomatic, and she had noticed this anomaly a month prior to consultation. She received intramuscular injections of corticosteroids of unknown dosage at the affected site for the treatment of allergic rhinitis 4 months prior to her present consultation. The second patient, a 23-year-old woman, appeared at our hospital complaining of a similar macule 4 x 4 cm in size, which she noticed several weeks prior to her most recent consultation. She had no history of injury or injection at the site before the development of the condition (Fig. 1b). She had been under treatment for atopic dermatitis since early childhood and was treated only with topical applications of white petrolatum containing 2% salicylic acid for the past several years. In order to rule out the possibility of acquired partial lipodystrophy associated with localized scleroderma, lupus profundus and the other connective tissue diseases, a histological examination was performed for both patients. Histopathological analysis of the region exhibited a well-defined fat lobule composed of numerous small adipocytes (Fig. 1c) embedded in hyaline connective tissue. Edema and dilated capillaries were noticeable in the subcutaneous tissue surrounding the area. Inflammatory cells were not prominent, although mononuclear cells were observed in both patients. No epidermal change was seen in either patient. Direct and indirect immunofluorescence studies revealed no deposits of immunoreactants in the skin of either patient. Immunohistochemical studies with the antibody against macrophage (anti-CD68 antigen; DAKO.) showed that positive cells were scattered around blood vessels and shrunken lipocytes in the subcutaneous tissues (Fig. 1d). Most of these cells in the fat lobules were also positive for mucin stains such as Alcian blue. No abnormal findings came to light in the ordinary hematological and blood chemistry examinations of both patients. The autoantibody screening tests using antinuclear, anti-DNA, anticentromere, and anti-Scl-70 antibodies were negative in both patients.
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PMID:Two Japanese cases of localized involutional lipoatrophy. 1201 Mar 46

Poly-L-lactic acid, a synthetic biodegradable polymer, is available as an injectable intradermal implant for use in the correction and restoration of the signs of facial lipoatrophy in patients with HIV infection. In a 96-week noncomparative study in HIV-infected patients with severe facial lipoatrophy, 41% of patients treated with intradermal poly-L-lactic acid injections had a total cutaneous thickness of >10 mm at the nasogenian fold at week 24. Poly-L-lactic acid was injected into multiple sites of each cheek at baseline and at weeks 2, 4, and 6. Significant (p < 0.001) increases from baseline in total cutaneous thickness were reported at all evaluation time points up to 96 weeks after the start of treatment. In a randomized, nonblind study, significant (p < 0.001) increases from baseline in dermal thickness were observed at week 24 in HIV-infected patients with facial lipoatrophy who received immediate or deferred (by 12 weeks) treatment with poly-L-lactic acid, administered by injection into multiple intradermal sites every 2 weeks (three injection sessions in total). Improvements in depression and anxiety scores, patient visual analog scale assessments, and photographic assessments were also reported in patients treated with poly-L-lactic acid in the immediate versus deferred treatment trial. Poly-L-lactic acid was generally well tolerated. No serious adverse events were reported.
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PMID:Poly-L-lactic acid. 1555 38

An informal yet comprehensive literature review of abstracts published in Medline was undertaken to identify papers that reported on how facial aging, lipodystrophy, and facial lipoatrophy affect quality of life. Facial lipoatrophy can erode self-esteem, cause psychological distress, and lead to depression. Persons with HIV infection encounter both stigmatization and marginalization as a result of facial lipoatrophy. In addition to exploring novel antiretroviral therapies that do not result in lipodystrophy, clinicians should consider treatments that correct the appearance of lipoatrophy for patients who feel adversely affected by the condition.
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PMID:Relationship between lipoatrophy and quality of life. 1604 80

Prolonged antiretroviral therapy, particularly with thymidine analogue-based regimens, may lead to generalized lipoatrophy. The facial changes associated with lipoatrophy are highly stigmatizing, affecting quality of life and decisions around therapy. Changes in antiretrovirals to thymindine-sparing regimens may lead to gradual fat recovery but, even over several years, may not result in impressive restoration of appearance. The need for a rapid and effective panacea for facial changes has led to investigation of a range of cosmetic treatments to enhance facial appearance. Surgical fillers, which may be either permanent or biodegradable, are the mainstay of cosmetic management. These treatments not only lead to improved physical appearance but also may reduce social anxiety and depression.
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PMID:Plastic surgical approaches for HIV-associated lipoatrophy. 1609 Dec 59

The aim of this observational, prospective, nonrandomized study was to assess long-term psychometric outcomes of surgical treatment of HIV-related facial lipoatrophy. Two hundred ninety-nine participants (70.8% male) consecutively attending the Metabolic Clinic of Modena and Reggio Emilia University from November 2005 to July 2006, undergoing surgical interventions for HIV-related facial lipoatrophy were enrolled. Fifty-four (18.1%) underwent facial lipofilling, which consists of the harvesting of a small, intact parcel of fatty tissue with processing that removes the nonviable components and of the transport of fatty parcels through a small cannula to implant the graft in a manner that provides nutrition and anchors the fat to the host tissue. After an initial lipofilling, 24 (8%) needed polylactic acid injections to correct cheek asymmetry, 91 (30.4%) received only polylactic acid infiltrations, and 130 (43.5%) polyacrylamide infiltrations only. Subjective outcome measures were face aesthetic satisfaction, body image perception, depression evaluated by a visual analogue scale (VAS), the Assessment of Body Change and Distress questionnaire (ABCD), and by the Beck Depression Inventory questionnaire, respectively. Objective measure was cheek thickness evaluated by a 7.5-MHz frequency ultrasound probe perpendicular to the skin surface at the nasolabial fold, the corner of the mouth, the zygomatic arch, and centrally between these points in the buccal fat pad area. Both subjective and objective variables were evaluated at baseline and 48 weeks after end of surgical treatment. All 299 participants had significant improvement of the aesthetic satisfaction for the face (VAS from 2.9 +/- 2.1 to 6.2 +/- 2.1, p < 0.0001), of body image satisfaction (ABCD question 7 from 3.8 +/- 1 to 3.1 +/- 1 p < 0.0001 and ABCD question 8 from 70.7 +/- 16.7 to 77.2 +/- 17.2 p < 0.0001), of depression score (Beck score from 11.4 +/- 8.3 to 9.4 +/- 7.8 p = 0.001). Participants experienced a significant augmentation of both cheeks' thickness (right cheek from 4.3 +/- 1.9 mm to 9.5 +/- 3 mm p < 0.0001, left cheek from 4.4 +/- 2 mm to 9.6 +/- 3.1 mm, p < 0.0001). Our data suggest that facial surgery is an important option in the treatment of HIV-related lipoatrophy as an integral part of the management of HIV infection, because of the important and lasting psychological benefits.
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PMID:Long-term psychometric outcomes of facial lipoatrophy therapy: forty-eight-week observational, nonrandomized study. 1824 Aug 93

Localized involutional lipoatrophy (LIL) was first described in 1986 as a distinctive idiopathic form of localized lipoatrophy characterized by loss of adipose tissue without antecedent inflammation. Clinically, LIL usually presents as a solitary, asymptomatic, well-demarcated, atrophic depression and often involves areas of antecedent intramuscular or intra-articular injections. Histologically, changes in the subcutaneous fat in LIL resemble fetal adipose tissue. Only rarely has there been any description of epidermal or dermal changes occurring with LIL. We describe two cases of LIL with overlying hypopigmentation and atrophy, and with morphea-like changes on histology. Recognition of these changes may have clinical and diagnostic implications.
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PMID:Localized involutional lipoatrophy with epidermal and dermal changes. 1828 Mar 48

Facial lipoatrophy can be obvious and stigmatising. Poly-L-lactic acid (PLLA) has been used widely for the correction of HIV-associated facial lipoatrophy. Analysis of the PLLA treatment protocols of 441 consecutive patients was undertaken. Product dilution, product volume per session, number of sessions, time between sessions, facial areas treated, plane of injection and incidence of injection-site nodules were recorded. Assessments included the Hospital Anxiety and Depression Scale and the Appearance Satisfaction Questionnaire. During the learning curve 30 patients were treated every 2 weeks for a minimum of three sessions. A 3-ml dilution was used and a total of 5 ml was injected in the deep dermis of the buccal areas. The incidence of nodule formation was 31% and 52% of patients did not achieve resolution of their facial disfigurement. A total of 411 patients were treated every 4 weeks for a minimum of four sessions. A minimum 5-ml dilution was used and a minimum total of 10-ml was injected subcutaneously in the temporal, infraorbital and buccal areas. The incidence of nodule formation was 2.9% and 10% of patients did not achieve resolution of their facial disfigurement. Patient anxiety and depression scores and appearance satisfaction scores improved significantly with treatment.
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PMID:The face of HIV and AIDS: can we erase the stigma? 1844 27

In the last decade, the number of cosmetic procedures performed in the United States has rapidly increased. While physicians historically have focused on minimizing side effects and optimizing the physical outcome, a broad spectrum of patient needs also factors in treatment success. Unfortunately, few data are available regarding the effects of cosmetic procedures on patient's self-esteem, confidence, relationships, and acceptance by others. Quality of life represents a relevant and important long-term measurement of outcomes in these patients. Studies have shown that cosmetic surgery can have a positive impact on patient quality of life. In contrast, fewer data are available regarding the effects of nonsurgical cosmetic procedures on quality of life. Much of the quality-of-life data regarding nonsurgical cosmetic procedures focuses on patients with human immunodeficiency virus-associated facial lipoatrophy, a condition associated with depression, problems with self-esteem and interpersonal relationships, in addition to nonadherence to the treatment. Recent data indicate that cosmetic treatment of human immunodeficiency virus-related facial lipoatrophy with injectable facial rejuvenators can improve quality of life in these patients. However, there is a dearth of quality-of-life data on patients who undergo facial rejuvenation procedures using the newer injectable devices, such as hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid. Future studies should focus on developing standardized tests to assess quality of life in patients undergoing facial rejuvenation interventions. More data obtained from validated assessment tools are needed to systematically evaluate the effects specific treatments have on satisfying the needs of the cosmetic patient.
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PMID:The impact of cosmetic interventions on quality of life. 1906 62

HIV-associated lipoatrophy may affect up to 35% of patients who have received antiretroviral (ARV) regimens for more than one year, and may result in depression, social isolation, and career barriers. Interventions including the injection of dermal fillers for restoration of facial fat loss are being used for treating HIV-associated lipoatrophy. Since reimbursement is often lacking, patients must consider the pros and cons of such interventions, weighed against the other costs of daily life. The primary goal of the study is to provide reliable estimates of the costs of treating HIV-associated lipoatrophy, specifically facial lipoatrophy. Costs are provided for a single site and are estimated from published studies reporting administration patterns of dermal fillers, publicly available list prices, and physician service fees for similar subcutaneous injections of the face. Fourteen studies were identified that reported experience with five dermal fillers used to treat HIV-associated facial lipoatrophy: poly-L-lactic acid, calcium hydroxylapatite, polyalkylimide gel, hyaluronic acid, and silicone oil. Typical courses involve four physician visits, but could vary from 1 to 13. The cost of a course of dermal filler treatment at a single site ranges across four products (all other than hyaluronic acid) from $3690 to $16,544, and is typically not covered by the payers. Physician fees for an entire course of similar outpatient procedures reimbursed by insurers are approximately $500, and may vary according to location, specialty, and market conditions. These procedures need to be repeated per site injected with intervals of 1-3 years. Treatment of HIV-associated lipoatrophy may represent a considerable out-of-pocket expense for many patients with HIV. This could have implications for deciding whether to undergo a restorative procedure, which procedure to undergo, and whether to pursue other options that may include switching ARV regimens.
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PMID:Cost consequences of HIV-associated lipoatrophy. 1944 76


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