Adiposis dolorosa (AD) is a disease that usually affects women, but has also been observed in men [1] [2]. It rarely occurs in children. It is frequently reported in peri-menopausal women, although 35-50 years is the age range often stated in literature [3]. AD presents with generalized obesity, as well as numerous, painful lipomas which vary in size, primarily affecting the torso and extremities, although there is no involvement of the hands. AD does not affect the face.

Other commonly associated symptoms are fatigue, weakness, chronic pain, thinning pubic hair, and various gastrointestinal problems. Pain is progressive, increases with body mass index (BMI), and may be severe enough to limit mobility and disrupt daily activity [1] [2]. It may also be experienced as tenderness on palpation or as transient episodes, and is affected by changes in weather and temperature [4].

Patients may present with easy bruising, angiolipomas, menstrual changes, bleeding diatheses, migraines, joint pain or stiffness, and myalgias. More general symptoms such as non-pitting edema, dyspnea, tachycardia and fatigue have been reported [2]. Memory impairment, difficulties in thought processes, sleep derangements, depression, anxiety, and other psychiatric disorders can occur.

AD may be classified into Type I, with widespread distribution of painful fat tissue without recognizable lipomas (generalized diffuse form); Type II, with pain in both diffuse adipose tissue and in localized lipomas (generalized nodular form); Type III, with pain in numerous lipomas (localized nodular form); and type IV, with singular fat accumulations near the joints (juxta-articular form) [5]. There are cases of a familial form of AD, with an autosomal dominant pattern of inheritance [5]. The particular gene mutation has not yet been discovered.

Proposed precipitating factors are prolonged high dose steroid use, trauma, endocrine or adipose tissue abnormalities, as well as autoimmune conditions [5] [6].

• Pain

  Generalised diffuse form A form with diffusely widespread painful adipose tissue without clear lipomas, II. Generalised nodular form - a form with general pain in adipose tissue and intense pain in and around multiple lipomas, and III. [ncbi.nlm.nih.gov]

  Pain usually increases when a lipoma is bumped or pressed. In some cases, just clothing touching the skin is enough to cause pain. [web.archive.org]

  pain in Dercum's disease. [en.wikipedia.org]

• Fatigue

  Other commonly associated symptoms are fatigue, weakness, chronic pain, thinning pubic hair, and various gastrointestinal problems. [symptoma.com]

  It is might be associated with obesity, emotional features or fatigue. Females are more likely to develop this disease than men. Tumors are painful and present in multiples on extremities. It occurs in the age of 35-50 years. [curerator.com]

  The majority reported pain, fatigue, weight gain (25.7 ± 15 kg), multiple growths, and weakness at onset. The median number of palpable growths was 77.3 ± 84.5 in subcutaneous fat from scalp to dorsal foot. [doi.org]

  Fibromyalgia syndrome is a common and chronic disorder characterised by widespread muscle pain, fatigue, and multiple tender points. [books.google.ro]

• Weight Gain

  It may be associated with thyroid dysfunction and may present as persistent fatigue and weight gain despite biochemical euthyroidism. [endocrine-abstracts.org]

  In some cases, affected individuals may also experience weight gain, depression, lethargy, and/or confusion. The exact cause of Dercum’s disease is unknown. [diseasesdic.com]

  The majority reported pain, fatigue, weight gain (25.7 ± 15 kg), multiple growths, and weakness at onset. The median number of palpable growths was 77.3 ± 84.5 in subcutaneous fat from scalp to dorsal foot. [doi.org]

  Significant weight gain is a common occurrence for most individuals affected by Dercum’s disease. [rarediseases.org]

  The patient experienced recurrent weight gain and lipoma pain with discontinuation of these medications. [38] Desai et al reported on treatment with a lidocaine (5%) patch, [39] and Lange et al reported on successful therapy with pregabalin with manual [emedicine.medscape.com]

• Weight Loss

  Weight loss does not result in pain relief or resolution of the lipomas. Surgical options include liposuction or excision. Recurrence of the lipomas after surgical removal, either at the same site or at other locations, is common. [orpha.net]

  Dercum's disease, Dercum disease Overview Adiposis dolorosa, also known as Dercum's disease (and which is different from Ander's disease in which painful or painless fatty growths resolve with weight loss), is a rare disease characterized by multiple [checkorphan.org]

  loss, inflammation, increased fluid in adipose tissue (lipedema and lymphedema), and hyperalgesia. [dx.doi.org]

  Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat accompanied by fatigue, difficulty with weight loss, inflammation, increased fluid in adipose tissue (lipedema and lymphedema), and hyperalgesia. [ncbi.nlm.nih.gov]

• Fever

  Some patients report feeling hot; in rare cases adiposis dolorosa is associated with low-grade fever. Morning stiffness may occur. [clinicaladvisor.com]

  It predominantly affects middle age men of mediterranean origin A systemic disease, often associated with arthritis, fever, and weight loss. The cutaneous lesions consist of histiocytes, which are usually confined to the dermis. [icd9data.com]

  Still, other symptoms may present themselves, such as a long-term, low-grade fever, minor headaches, and random, otherwise unexplained swelling or bruising of body parts. Adiposis dolorosa is a rare disease, therefore detailed research is lacking. [wisegeek.com]

• Knee Pain

  It manifests mainly on the medial parts of the knees. Pain and impaired mobility are common symptoms. We report on four females (aged between 52 and 83 years) who suffered from juxta-articular adiposis dolorosa for more than 10 years. [ncbi.nlm.nih.gov]

  Report of 2 cases Annals of the Rheumatic Diseases 38(5): 479-482 1979 Juxta-articular adiposis dolorosa may be defined as the localised accumulation of painful fat near joints, most commonly the knee. [eurekamag.com]

• Dry Eyes

  I also have the other symptoms of this disorder, including dry eyes and mouth, IBS and lipolymphedema. I take as little pain medicine as possible and find joy in living despite my limitations. [wisegeek.com]

  Additional reports in the medical literature have linked Dercum’s disease to a variety of conditions including arthritis, high blood pressure (hypertension), congestive heart failure, sleep disorders, dry eyes, and myxedema, a condition due to an underactive [rarediseases.org]

• Subcutaneous Nodule

  A 41-year-old woman with painful subcutaneous nodules. N Engl J Med. 2006;355:714-722. Wortham NC, Tomlinson IP. Dercum’s disease. Skinmed. 2005;4:157-62. Steiner J, Schiltz K, Heidenreich F, Weissborn K. [rarediseases.org]

  A 41-year-old woman with painful subcutaneous nodules". N Engl J Med. vol. 17;355. 2006. pp. 714-22. Copyright © 2017, 2012 Decision Support in Medicine, LLC. All rights reserved. [clinicaladvisor.com]

  A 41-year-old woman with painful subcutaneous nodules”. N Engl J Med. vol. 17;355. 2006. pp. 714-22. (A well-written differential diagnosis of adiposis dolorosa and its management.) Copyright © 2017, 2013 Decision Support in Medicine, LLC. [dermatologyadvisor.com]

  A 41-year-old woman with painful subcutaneous nodules. N Engl J Med. 2006;355:714–22. CrossRef PubMed 27. Herbst KL, Asare-Bediako S. Adiposis dolorosa is more than painful fat. Endocrinologist. 2007;17:326–34. CrossRef 28. [springermedizin.de]

• Sparse to No Axillary Hair

  Sparse pubic and axillary hair have also been reported. Etiology The aetiology remains unknown but several hypotheses have been proposed including an autoimmune mechanism, alterations in fatty acid or carbohydrate metabolism and endocrine anomalies. [orpha.net]

• Skin Thickening

  All cases in the first two groups demonstrated skin thickening and lymphedema of subcutaneous fat, which was fluid attenuation on CT and low or intermediate T1-weighted and high STIR/T2-weighted MR signal. [ncbi.nlm.nih.gov]

• Neck Swelling

  We report a case of a 48-year-old woman with recurrent neck swelling and pain in the neck and parotid region, and a review of management of this uncommon problem. [ncbi.nlm.nih.gov]

  We report a case of a 48-year-old woman with recurrent neck swelling and pain in the neck and parotid region, and a review of management of this uncommon problem. ( info) 2/21. [lookfordiagnosis.com]

• Impulsivity

  It may block impulse conduction in peripheral nerves, and thereby disconnect abnormal nervous impulse circuits. Nonetheless, it might also depress cerebral activity that could lead to increased pain thresholds. [en.wikipedia.org]

  It may block impulse conduction in peripheral nerves [ 21 ], and thereby disconnect abnormal nervous impulse circuits [ 102 ]. [doi.org]

• Compulsive Disorder

  Post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and generalised anxiety disorder (GAD) have been expressly described in a community sample of patients with fibromyalgia [ 16 ]. [doi.org]

• Psychiatric Manifestation

  Furthermore, in 1930, Gram presented 69 cases of Dercum’s disease and he did not note explicit psychiatric manifestations in any them [ 11 ]. [doi.org]

• Headache

  (e.g., tension headaches, classic migraine, neck headaches) Diagnostic Modalities Laboratory tests are very nonspecific. [academic.oup.com]

  […] dementia confusion memory issues depression the difficulty with concentration rapid heart beat bruised easily obesity shortness of breath painful fatty lipomas stiffness trouble with sleeping diabetes bloating joint aches emotional instability constipation headache [curerator.com]

  Some patients may have headaches or difficulty sleeping. Diagnosis Dercum's disease is very rare and difficult to diagnose, and there are no tests that can be used to conclusively diagnose the condition. [web.archive.org]

  Other symptoms include swelling of fingers, general tiredness, tendency to bruise with normal coagulation tests, morning stiffness, headaches, cognitive dysfunction and bouts of depression. [edoj.org.eg]

• Dysarthria

  The disorder was associated with dysarthria, visual pursuit defect and progressive dystonia. MRI showed bilateral increasing cystic lesions in the basal parts of the putamen. No other abnormalities were detected. [lookfordiagnosis.com]

  Lim HW 2007 20 Dercum's disease (adiposis dolorosa): a new case-report. ( 15050201 ) Amine B...Benhamou CL 2004 21 Dercum's disease (Adiposis dolorosa): delayed diagnosis in a patient with cervical cancer. ( 15690837 ) George R...Isaiah R 2004 22 Dysarthria [malacards.org]

  The affected subjects developed associated dysarthria, visual pursuit defects and progressive dystonia. Magnetic resonance imaging revealed bilateral increasing cystic lesions in the basal parts of the putamen. [doi.org]

The confirmation of adiposis dolorosa is based on certain diagnostic criteria, with minimum requirements of being obese or overweight, and experiencing chronic pain in fat tissue for 3 or more months [5]. Physical exam is adequate for making a diagnosis. Dissection of resected masses can further solidify the diagnosis [7]. Reaching the correct diagnosis may be challenging due to varying presentations.

Imaging techniques, including ultrasound and magnetic resonance imaging (MRI), can be used non-invasively to ensure that the masses are lipomas [8] [9] [10]. Laboratory tests may be carried out to exclude any suspected endocrine disorders such as thyroid or adrenal disease. High erythrocyte sedimentation rate (ESR), alpha-1 antitrypsin, haptoglobin, and complement levels may be noted [11].

Management and treatment Treatment is symptomatic. Pain may be relieved by intravenous administration of lidocaine, local corticosteroid (prednisone) injections and combinations of mexiletine and amitriptyline, or infliximab and methotrexate. [orpha.net]

Ultrasound and magnetic resonance imaging can play a role in diagnosis. [9] Treatment [ edit ] Common treatments for Dercum's disease is directed towards treating the individual symptoms. [en.wikipedia.org]

The cause is unknown, and there is no specific treatment. Pain may be relieved by steroids, intravenous lidocaine, or analgesics. Surgical treatment consists of excision or liposuction of the painful masses. [ncbi.nlm.nih.gov]

Prognosis The disease course is chronic and progressive. The documents contained in this web site are presented for information purposes only. [orpha.net]

Adiposis Dolorosa Prognosis and Diagnosis The prognosis of Dercum’s disease is that it’s a chronic condition that develops gradually. [myphiladelphiadisabilitylawyer.com]

Prognosis - Adiposis dolorosa Not supplied. Treatment - Adiposis dolorosa Resources - Adiposis dolorosa [checkorphan.org]

Prognosis Adiposis dolorosa tends to be a chronic disease that does not abate over time and may progress to become more debilitating as time goes on. [statpearls.com]

Dercum's disease mainly occurs in adults and more women are affected than men. (1) Etiology T he specific etiology of Dercum's Disease is unknown. [web.archive.org]

The etiology is uncertain, but is probably multifactorial. Numerous treatments to relieve the pain have generally been unsuccessful. A patient with adiposis dolorosa was treated with intravenous infusions of lidocaine over a two-year period. [ncbi.nlm.nih.gov]

Etiology The aetiology remains unknown but several hypotheses have been proposed including an autoimmune mechanism, alterations in fatty acid or carbohydrate metabolism and endocrine anomalies. [orpha.net]

Definition / general Tender accumulations of subcutaneous fat / lipomas, often in pelvis and lower extremities of postmenopausal women Terminology Also called Dercum disease Epidemiology Associated with women, obesity, hypercholesterolemia Clinical features [pathologyoutlines.com]

Summary Epidemiology Prevalence is unknown. The disease usually occurs in postmenopausal women between 45 and 60 years of age but a few cases have been reported in males. [orpha.net]

Most cases of the disease are found to be sporadic with no specific genetic mutations. [3] [4] [5] Epidemiology No significant epidemiologic data is available but based on case reports adiposis dolorosa is found more frequently in obese females ages 35 [statpearls.com]

Understanding the pathophysiology and metabolism of lipomatosis in AD may contribute to a better understanding of metabolism in non-lipomatosis obesity. [ncbi.nlm.nih.gov]

In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may [skincareguide.ca]

Pathophysiology The pathophysiology of this rare disease is unknown. Recent studies suggest that the lipomatosis in this disease is inflammatory and involves elevated interleukin (IL)-6 and connective tissue was increased fourfold. [clinicaladvisor.com]

Possible risk factors include obesity, alcohol abuse, liver disease, glucose intolerance, and soft tissue trauma (see “Etiology and Pathophysiology”). [unboundmedicine.com]

Prevention High quality scientific evidence regarding prevention of Dercum's disease is currently lacking. [web.archive.org]

Knowledge of these conditions and the characteristic imaging findings is important to prevent unnecessary biopsy and misdiagnosis. [ncbi.nlm.nih.gov]

Prevention - Adiposis dolorosa Not supplied. Diagnosis - Adiposis dolorosa A diagnosis of Dercum's disease is based on what the patient tells and what the doctor finds at his examination. [checkorphan.org]

Thus, early recognition of lipedema by its clinical manifestations is necessary to prevent complications such as ischemia. Full Text : Mutnal S, Rangappa P, Jacob I, Chaitanya K, Rao K. [dercumsdiseaseresearch.wordpress.com]

1. Learning About Dercum Disease. National Human Genome Research Institute. http://www.genome.gov/17516629. Updated June 27, 2012. Accessed March 6, 2018.
2. Dercum's Disease. Fat Disorders Research Society. http://www.fatdisorders.org/fat-disorders/dercums-description. Accessed March 6, 2018.
3. Campen R, Mankin H, Louis DN, Hirano M, Maccollin M. Familial occurrence of adiposis dolorosa. J Am Acad Dermatol. 2001;44(1):132-136.
4. Brodovsky S, Westreich M, Leibowitz A, Schwartz Y. Adiposis dolorosa (Dercum's disease): 10-year follow-up. Ann Plast Surg. 1994;33(6):664-668.
5. Hansson E, Svensson H, Brorson H. Review of Dercum's disease and proposal of diagnostic criteria, diagnostic methods, classification and management. Orphanet J Rare Dis. 2012;7:23.
6. Adiposis dolorosa. Genetics Home Reference. http://ghr.nlm.nih.gov/condition/adiposis-dolorosa. Reviewed July, 2012. Accessed March 6, 2018.
7. Dercum's disease. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/dercums-disease/. Accessed March 6, 2018.
8. Amine B, Leguilchard F, Benhamou CL. Dercum's disease (adiposis dolorosa): a new case-report. Joint Bone Spine. 2004;71(2):147-149.
9. Tins BJ, Matthews C, Haddaway M, et al. Adiposis dolorosa (Dercum's disease): MRI and ultrasound appearances. Clin Radiol. 2013;68(10):1047-1053.
10. Petscavage-Thomas JM, Walker EA, Bernard SA, Bennett J. Imaging findings of adiposis dolorosa vs. massive localized lymphedema. Skeletal Radiol. 2015;44(6):839-847.
11. Greenbaum SS, Varga J. Corticosteroid-induced juxta-articular adiposis dolorosa. Arch Dermatol. 1991;127(2):231-233.