Human Insulin–Induced Lipoatrophy A successful treatment with glucocorticoid

B efore the development of purifiedinsulin in the 1970s, lipoatrophywas a common complication of in-sulin therapy (1,2). With the arrival of human insulin, lipoatrophy has de-creased dramatically, becoming a rare problem in clinical practice. Lipoatro-phies are considered an adverse immuno-logical side effect of insulin therapy, and in some cases they are mediated by a local high production of tumor necrosis fac-tor-, which leads to a dedifferentiation of adipocytes in the subcutaneous tissue. The treatment with corticosteroids is use-ful because of its immunomodulating properties and also because it is able to produce a differentiation of adipocytes (2–4). In most reported cases of insulin-induced lipoatrophies, there were at-tempts of changing the injection areas without any evidence of improvement (5– 8). Kumar et al. (9) in a single-blind study used small amounts of dexamethasone, adding 4 g/unit to insulin injections, in nine patients with marked lipoatrophy in both thighs. A mix of insulin and dexa-methasone was injected into one thigh and insulin without dexamethasone was injected into the other. This way, each pa-tient was her own control subject. Six pa-tients showed significant improvement. None used human insulin (9). We report a case of localized lipoat-rophy in a patient treated with human insulin since the onset of type 1 diabetes when the application of betamethasone was effective in stopping and reversing this abnormality