Subcutaneous Atrophy

Intralesional triamcinolone acetonide has been used extensively for the treatment of hypertrophic and keloid scars. Complications are few, usually being local skin color changes, prominent vascular markings, or subcutaneous atrophy. Cushing s syndrome after intralesional administration of triamcinolone acetate has been described in two adults and two children (aged 10 years and 21 months) after treatment of hypertrophic burn scars with intralesional triamcinolone acetonide (SEDA-21, 419) (408). These two children may have had a form of hypersensitivity to triamcinolone acetonide, as Cushing s syndrome was not the result of overdosage. 

Intra-articular and periarticular administration Local injections of glucocorticoids into and around the joints can have a dramatic therapeutic effect, but the catabolic effect can have serious consequences, including adverse effects on joint structure (461) and on local tendons, subcutaneous atrophy, and possibly osteonecrosis. Provided the state of the joint is carefully inspected before any new injection is given, and the interval between the injections is not less than 4 weeks, the risk seems to be small enough to justify treatment in invalidating cases (SEDA-3, 307). 

The local outcome of jelly fish-provoked dermatitis may be constituted by keloids, dyschromia, scarring, subcutaneous atrophy and gangrene. 

Impaired wound healing, thin fragile skin, petechiae, ecchymoses, erythema, increased sweating, suppression of skin test reactions, subcutaneous fat atrophy purpura, striae, hyperpig mentation, hirsutism, acneiform eruptions, urticaria, angioneurotic edema... 

Organophosphate ester hydraulic fluids may cause adverse reproductive effects based on observations of testicular atrophy in rats after continuous inhalation exposure to 101 mg/m3 Durad MP280 for 90 days (MacEwen and Vemot 1983), loss of spermatic elements and degeneration in the seminiferous tubules in dogs given 20 subcutaneous injections of Cellulube 220 at doses ranging from 100 to 500 mg/kg/day... 

Reproductive effects (testicular atrophy, degeneration) have been observed in male rats after intermediate-duration inhalation exposure at 1,000 ppm -hexane and at 5,000 ppm (De Martino et al. 1987 Nylen et al. 1989). Atrophy of the testicular germinal epithelium was also observed in an oral exposure in rats at 4,000 mg/kg/day (Krasavage et al. 1980). Severe neurotoxicity occurred in all these studies. These effects were not observed in studies in rats using lower concentrations of -hexane or in mice exposed via inhalation to up to 10,000 ppm for 13 weeks (Dunnick et al. 1989 NTP 1991). A decrease in ventricular fibrillation potential has been observed in perfused hearts from rats exposed subcutaneously for an intermediate duration to -hexane (Khedun et al. 1996). 

Repository injections To minimize the likelihood and severity of atrophy, do not inject subcutaneously, avoid injection into the deltoid, and avoid repeated IM injections into the same site, if possible. Repository injections are not recommended as initial therapy in acute situations. 

The involvement of testosterone in the testicular atrophy caused by di(2-ethyl-hexyl) phthalate was examined by co-administration of testosterone (1 mg/kg bw) subcutaneously with 2000 mg/kg bw di(2-ethylhexyl) phthalate [purity not specified] in groundnut oil to adult male Wistar rats for 15 days (Parmar et al., 1987). Administration of di(2-ethylhexyl) phthalate reduced the sperm count and also significantly increased the activity of y-GT, lactate dehydrogenase and P-glucuronidase and decreased the activity of sorbitol dehydrogenase and acid phosphatase. Co-adminis-tration of testosterone seemed to normalize the sperm count and the activity of testicular enz5mies. The role of testosterone in the testicular toxicity of di(2-ethylhexyl) phthalate has not been fully elucidated. Several reports refer to increased or decreased testosterone levels in plasma and testicular tissue. 

Injection of animal insulin preparations sometimes led to atrophy of subcutaneous fatty tissue at the site of injection. This type of immune complication is almost never seen ever since the development of human and analog insulin preparations of neutral pH. Injection of these newer preparations directly into the atrophic area often results in restoration of normal contours. 

Lipodystrophy can also result from insulin therapy and is characterized by atrophy of subcutaneous fat. Insulin edema is manifested by a generalized retention of fluid. Insulin resistance arises when there is an excess insulin requirement that exceeds 200 units per day. 

Adverse effects observed with insulin Note lipodystrophy is a local atrophy or hypertrophy of subcutaneous fatty tissue at the site of injections. 

Complications after steroid injection are minimal but can occur.The patient can expect slight discomfort at the injection site and occasionally subcutaneous white (steroid) deposits in the treated area. Depigmentation of the eyelid at the injection site, especially in dark-skinned individuals, and temporary skin atrophy can also occur. Skin depigmentation can be minimized by using a transconjunctival rather than a transepidermal injection in persons of color. When depigmentation occurs, it is... 

Fig. 16.7 Massive refractory ascites with large umbilical hernia. Muscular atrophy and loss of subcutaneous fatty tissue...

Two distinct types of skin lesions have been described in patients taking pentazocine scleroderma-like changes, subcutaneous abscesses, cellulitis, ulceration, muscle atrophy and granulomas (all of which are well-recognized consequences of pentazocine abuse), and a generalized erythematous desquamative rash. 

The hands have aged completely when superficial photoaging and solar lentigines are combined with atrophy of the integuments, subcutaneous tissue, muscles and bones. Peels do not correct hormone-induced atrophy, and often the only option is fat transfer combined with chemical peels (Figures 19.6 and 19.7). 

Marasmus results from deficiency of protein and energy intake, as in starvation, and results in generalized wasting (atrophy of muscles and subcutaneous tissues, emaciation, loss of adipose tissue) Edema occurs in kwashiorkor but not in marasmus however, the distinction between these disorders is not always clear. The treatment of marasmus requires supplementation of protein and energy intake. 

Impaired wound healing Inhibition of leukocyte and monocyte function Subcutaneous tissue atrophy Glaucoma... 

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