Household Hazards

How everyday products make us sick.

Workstation Woes

Report of an emerging health problem in office workers

This summer, a leading workplace health journal published a report of an emerging problem in office workers. This relatively new condition carries the ominous sounding name, "Lipoatrophia semicircularis." By comparison, carpal tunnel syndrome comes trippingly off the tongue. Lipoatrophia semicurcularis (let's just call it LS) simply means a semi-circular line of wasting or atrophy involving fat deposited near the body's surface. This appears as an arching, narrow depression in the skin, typically manifested on the front of thighs (although it can be on the arms, too). This unusual condition was only first reported in the medical literature a few decades ago and seemed to be extremely rare. Rare, that is, other than in certain populations of modern office workers.

The outbreak of LS documented in the July issue of the Journal of Occupational and Environmental Medicine (http://www.ncbi.nlm.nih.gov/pubmed/20595911) is one of the best studied to date. It involved more than 400 office workers in the area in and around Barcelona, Spain. More than half of those studied came from a single site where just over one in four workers had contracted LS, although even at the other sites studied the overall attack rate averaged 1 in10. These white collar workers shared a lot in common. More than 80% were women, but shared working conditions were even more impressive. The employees all worked at metallic desks with phenolic resin tops and with narrow edges. Moreover, all of these work stations were of a similar height, topped with computers and other standard electronic equipment, had minimal or no static electricity control, and were situated in offices with relatively low humidity. The most interesting aspect of this report is the program of rather low-tech interventions it describes, such as: specific grounding cables for the work tables, conductive carpeting, table edge protectors, and better humidification. Following those these changes, most of the LS cases resolved completely.

There is no proven mechanism for LS. The success of the intervention in Barcelona argues in support of one widely supported hypothesis - that electrical stimulation of fat cells leads to the atrophy. It seems that the non-insulated edge of a non-grounded desk laden with electrical equipment can make an efficient low-grade electrical charge delivery device. A counter argument had been that LS was simply a manifestation of direct pressure from the table tops or perhaps from extra tight clothing. This explanation does not seem to explain the phenomenon of relatively large outbreaks. The largest LS series (reported out of Belgium) involved more than a thousand persons. No occupational cases reported to date suggest that this condition, despite its aesthetic downside, evolves into something more sinister or threatening to health.

A curious aspect to this novel phenomenon is it geographic clustering in Western Europe. Published case reports from the United States, sometimes using the English language form "Semicircular Lipoatrophy," are few and far between, featuring sporadic non-work-related presentations of the condition that can occur in association with certain underlying diseases. Maybe our office desks are better grounded than in Fortress Europe. Or maybe it's just that nobody has noticed the connection over here.

Paul D. Blanc, M.D., M.S.P.H., is Professor of Medicine and Endowed Chair in Occupational and Environmental Medicine at the University of California San Francisco.

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