Contents
Definition
Dercum's disease / adipositas dolorosa is characterized by chronic pain and fat balls under the skin. Typically, tenderness and pain are particularly localized in fatty tissue. It is debated whether the condition is a separate disease or a combination of chronic pain in, for example Fibromyalgia and overweight with fat clusters (lipomas). The condition was described at the end of the 1800th century by the American neurologist Francis Xavier Dercum. There are (as of 2017) no systematic studies of the condition, only descriptions of individual cases. Some classify the condition among rare diseases associated with obesity and adiposity (rare adipose disorders, RADs)) which also include multiple symmetric lipomatosis (MSL) og lipødem.
Disease Cause
The underlying trigger is unknown. Fat clusters / lipomas can possibly press on nerves and trigger pain in predisposed individuals.
Symptoms
Typical is a combination of obesity (increased adipose tissue and obesity) and chronic pain in adipose tissue, particularly related to fat globules (lipomas). A number of other symptoms that have been described include exhaustion / fatigue, stiffness after being at rest, sleep difficulties, headaches, irritability and depression.
Examinations
Medical history register current symptoms (see above) and should also help rule out other chronic pain conditions such as fibromyalgia and lumps of a different composition, such as lymph nodes and various tumours.
Clinical fat globules are felt which are painful when pressed. Joints, muscles, skin and internal organs are assessed to rule out other conditions.
Blood and urine samples is not expected to show any special results. There are no tests that detect the disease. The examinations are carried out to rule out other diseases.
Imaging will show signs of fat globules during ultrasound and MRI examinations, but the changes do not differ from normal, painless fat accumulations.
Tissue sample (biopsy) expected to show adipose tissue without particular morbid changes.
Diagnosis
The diagnosis is based on the presence of pain located in or around fat globules (lipomas) in obese people. The pain must have lasted for at least three months. There must be no signs of another disease / explanation of the symptoms (reference: Cook JC, 2022).
Similar conditions, differential diagnoses
Dercum's disease, adipositas dolorosa, is a diagnosis of exclusion so that other causes must be ruled out.
- Fibromyalgia: Similar symptoms, without necessarily being overweight or fat accumulations/lipomas.
- Panniculitis: Inflammation in adipose tissue. Results in CRP and other blood tests.
- Familial Multiple Liopmatosis
- Lipødem
- Madelung's syndrome: benign lipomatosis
- Proteus syndrome: genetic overgrowth of various tissues, including fatty tissue
- hamartoma
- Gardener syndrome: intestinal polyps, fibromas, lipomas
Treatment
No particular therapy has been shown to be effective. You can try pain medications, but avoid long-term use of addictive drugs in case of chronic illness (the effect diminishes over time and side effects may exceed the effect). High doses cortisone (prednisolone) can relieve, but over a longer period of time side effects exceed benefits. Surgical removal of lipomas can provide temporary relief.
Measures other than drugs to manage chronic pain are important. This involves regular physical activity and relaxation if tension is present. Weight reduction in case of obesity.
