Corticosteroid-induced lipodystrophy (CIL) is a condition of
abnormal fat deposition caused by
corticosteroid medications.
Fat accumulates in the facial area ("
moon face
A Moon face is a medical sign in which the face develops a rounded appearance (reminiscent of the "Man in the Moon") due to fat deposits on the sides of the face.
Symptoms and causes
Moon face is often associated with Cushing's syndrome or stero ...
"), dorsocervical region ("buffalo hump"), and abdominal area ("pot belly" or "beer belly"), whereas the thickness of
subcutaneous fat
The subcutaneous tissue (), also called the hypodermis, hypoderm (), subcutis, superficial fascia, is the lowermost layer of the integumentary system in vertebrates. The types of cells found in the layer are fibroblasts, adipose cells, and macro ...
in the limbs is decreased.
The resulting appearance has been described as "Cushingoid",
in relation to the fact that it also occurs in individuals with
Cushing's syndrome
Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a ...
(abnormally high
cortisol levels).
The condition is considered by patients to be the most distressing side effect caused by corticosteroids.
Short-term therapy (<3 months) with 10 to 30 mg/day of a
prednisone
Prednisone is a glucocorticoid medication mostly used to suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium due to cancer and ad ...
equivalent has been reported to be associated with Cushingoid traits in 15 to 40%.
Long-term therapy (>3 months) with corticosteroids has been associated with Cushingoid features in 32 to 83% of individuals.
However, these symptoms have mostly been diagnosed in a subjective and observer-dependent manner.
In a prospective study, the cumulative incidence of CIL with high-dose prednisone therapy was found to be 61% after 3 months, 65% after 6 months, 68% after 9 months, and 69% after 12 months.
One study found that even a very low dosage of prednisone of 5 mg/day was associated with symptoms of "Cushing's syndrome".
It has been said that data on risk factors for CIL, such as corticosteroid dosage or duration of therapy, is surprisingly sparse.
Possible risk factors for CIL include high residual cortisol secretion, decreased clearance of corticosteroids, female sex, younger age (<50 years), high initial
body-mass index, and high
caloric intake.
CIL has been found to be usually reversible at prednisone-equivalent dosages of less than 10 mg/day.
A
low-calorie diet may be considered to limit the risk of CIL or to attempt to reverse it.
CIL is not merely an aesthetic adverse effect, as it has been associated with features of
metabolic syndrome such as
insulin resistance,
dyslipidemia
Dyslipidemia is an abnormal amount of lipids (e.g. triglycerides, cholesterol and/or fat phospholipids) in the blood. Dyslipidemia is a risk factor for the development of atherosclerotic cardiovascular disease ( ASCVD). ASCVD includes coronary ar ...
, and
high blood pressure.
See also
*
Steroid dementia syndrome
*
Steroid diabetes
*
Steroid-induced osteoporosis
Steroid-induced osteoporosis is osteoporosis arising from the use of glucocorticoids (a class of steroid hormones) analogous to Cushing's syndrome but involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug prednisone ...
*
Steroid induced skin atrophy
References
Corticosteroids
Cutaneous conditions
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