doi: 10.1111/j.1346-8138.2007.00295.

x Journal of Dermatology 2007; 34: 390 –393

CASE REPORT
Blackwell Publishing Asia

Lipoatrophia semicircularis: A compressive lipoatrophy

consecutive to persistent mechanical pressure
María Isabel HERANE, Francisco URBINA, Emilio SUDY
Cátedra de Dermatología, Escuela de Medicina, Universidad Andrés Bello, Santiago de Chile, Chile

ABSTRACT
Lipoatrophia semicircularis is an infrequent condition characterized by semicircular depressions of the anterolateral
aspects of the thighs. The origin of this peculiar variant of lipoatrophy is unknown, although repeated mechanical
trauma on the affected thighs has been advocated in many cases. A 57-year-old woman presented with a 1-year
history of two bilateral, parallel, symmetric, asymptomatic depressions on the anterolateral aspect of her thighs.
The patient worked as a cashier, permanently seated and almost always wearing trousers. The localization of
lesions and their linear artifactual appearance perfectly matched with the strangling folds formed by trousers while
being sat. Echotomographic examination revealed a loss of the normal echogenic pattern in the subcutaneous
tissue of the affected areas. We believe that the anatomical adipose constitution of women’s thighs predisposes
that a persistent mechanical pressure induced by wearing trousers while being sat for long periods of time,
originates a relative impaired circulation on a tenuous perfused tissue, and induces the development of lipoatrophia
semicircularis.
Key words: lipoatrophia semicircularis, lipoatrophy, localized lipoatrophy.

INTRODUCTION The origin of this peculiar variant of lipoatrophy is

Lipoatrophia semicircularis is an infrequent con-
dition characterized by semicircular depressions of
the anterolateral aspects of the thighs. Almost
exclusively described in healthy young women, it
presents as a localized, often bilateral, symmetrical
atrophy of the subcutaneous fat tissue. The lesions
appear as horizontal, 2–4 cm in width, band-like
cutaneous indentations with normal overlying skin.
When more than one depression is present, lesions
appear in a parallel arrangement.1 Multilocular and
progressive lesions affecting the trunk and limbs
have been described in an adipose patient.2 Until
1998, approximately 50 cases had been documented
in the published work.3 Histopathological studies
have been unspecific, showing inflammation of blood
vessels, and a partial or complete loss of the fat
replaced by newly formed collagen.4
unknown, although repeated mechanical trauma on
the affected thighs has been advocated. We hypothesize
a reasonable cause with respect to its origin.
CASE REPORT
A 57-year-old woman presented with a 1-year history
of two bilateral, parallel, symmetric, asymptomatic
depressions on the anterolateral aspect of her thighs,
which appeared as areas of cutaneous depressions,
3–4 cm wide, and 15 cm long (Fig. 1). The patient
worked as cashier, permanently seated and almost
always wearing trousers. Examined at her habitual
position being sat at work, her trousers’ folds matched
with the cutaneous bands (Fig. 2).
Echotomographic examination of the affected
areas showed symmetrical depressions of the sub-
cutaneous tissue of both thighs (more accentuated

Correspondence: Francisco Urbina, M.D., Algeciras 583, Las Condes, Santiago de Chile, Chile. Email: fcourbina@hotmail.com
Received 19 September 2006; accepted 29 November 2006.

390 © 2007 Japanese Dermatological Association


Figure 1. Two parallel and symmetrical depressions on
the anterolateral aspect of the left thigh.
on the left side), with a loss of the normal echogenic
pattern and compartmentalization. The lower lesion
at the left side reached a minimum thickness of
8.1 mm, while the right one measured 10 mm
(Fig. 3). Above and below the subcutaneous tissue
recovered its normal pattern of 10.6 or 12 mm. The
upper lesion showed similar characteristics.
She has continued using trousers although she
was advised to avoid them. The lesions have not
disappeared.
DISCUSSION
Different kinds of repetitive microtraumas have been
advocated with respect to the origin of lipoatrophia
semicircularis: pressure against chairs, ironing boards,
wash-basins, and edges of tables.5 Mascaró and
© 2007 Japanese Dermatological Association
Lipoatrophia semicircularis
Figure 2. The more prominent folds of the patient’s
trousers while being sat, perfectly matches the cutaneous
bands observed on physical examination.
Figure 3. Echotomographic view of the lower lesion show-
ing a depression of the subcutaneous tissue (* pointed
by arrows in the affected zone, and normalization * at both
extremes).
Ferrando6 were the first to suggest the possible role
of wearing tight jeans in the origin of this condition:
they described a 19-year-old woman with bilateral
lesions at the point of maximum pressure of the
jeans upon the thighs while being flexed on her
knees. A year after, they described the same
process in the sister of their patient, a women aged
23 who developed identical lesions after wearing
the discarded jeans.7 In both cases, the lesions
regressed after stopping the use of the jeans. We too
believe that the use of trousers in women influences
the development of lipoatrophia semicircularis, but
especially when acting as a persistent mechanical
391
M. I. Herane et al.
pressure, that is, while being sat for long periods of
time. It would be interesting to know if the apparition
of this process coincides with the time in which
women began to use trousers at work, because
no descriptions of it were done before the 1970s.8
Repeated pressure on the anterolateral aspect of
the thighs induced by trousers while being sat – as
illustrated in our case – could be the most common
and probable origin of semicircular lipoatrophy. The
physical constitution of women, with gross adipose
tissue at the thighs, could explain the predominance
of this condition with respect to males in whom
only a few cases have been described.9,10 Certain
anatomical individual variations on the tenuous
perfusion of the lateral aspect of the thighs could
also influence the origin of the process9 and perhaps
explain its low frequency of presentation. Repeated
trauma on the thighs does not constitute a reasonable
explanation for its development. One would expect
a higher incidence of lipoatrophy in sports or other
activities in which women (or men) are exposed to
repeated traumas, which in fact does not occur. On
the other hand, lipoatrophia semicircularis mostly
develops at a particular zone of the thighs, while
traumas could be obviously randomly distributed
at other different levels of the lateral aspect of the
thighs, sites where it has not been described. The
constant localization of lesions and its linear artifactual
appearance perfectly matches with the strangling
fold formed by trousers (not necessarily tight ones)
while sitting. The persistent mechanical pressure,
acting on gross adipose tissue that is not profusely
irrigated, determines a band of compression with
a loss of superficial subcutaneous adipose tissue.
Another possible cause of persistent mechanical
pressure is the use of an elastic girdle, which has
induced indentations on the thighs in at least two
cases, at the zones in which the lower edge of the
girdle contacted the thigh.11
Of considerable interest is the report of 18 cases
of lipoatrophia semicircularis in the same company:
12 women and six men, all office workers, presented
subcutaneous depressions on their thighs, mostly
bilateral, which were attributed to repeated pressure
against salient-edged furniture.5 The height of the
depression measured from the floor was constant
and it was the same as the height of the desks.
However, no comments were made in relation to the
392
use of trousers by desk workers. Similarly, other
cases were described in 10 employees of a firm,
6 months after the chairs had been replaced.1 Pressure
on the back of the thighs against the elevated front
edge of the seat, together with direct pressure from
the desk on the anterior thigh, was suggested as a
possible origin. The women described did not wear
tightly fitting jeans, but again it was not mentioned
if they obligatorily or predominantly worn trousers
as work clothing.1 In another report, seven cases
were described in office workers of a company (six
females and one male); the lesions were attributed
to repeated trauma to the thighs caused by the edge
of the desks; the thigh’s depressions were constantly
situated at 74 cm from the floor, corresponding
exactly to the height of the desks.12 No mention was
made, however, with respect to the use of trousers
at work in these patients.
In summary, we believe that the anatomical adipose
constitution of women’s thighs predisposes that a
persistent mechanical pressure induced by wearing
trousers while being sat for long periods of time,
originates a relatively impaired circulation on tenuous
perfused tissue, and induces the development of
lipoatrophia semicircularis.
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