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05/25/2011 09:11 AM

Emedicine on DD presentation


Adiposis Dolorosa

Author: Marjan Yousefi, MD; Chief Editor: Dirk M Elston, MD


◦Previously healthy women notice lumps or previously present lumps start growing. They describe pain and discomfort in the region of the lumps associated with weakness.

◦Before the onset of the disease, the patient is usually only slightly obese, but, in a short time, the patient becomes overweight.

◦The pain increases with the increase in fatty tissue and in connection to menstruation.

•Types and location

◦The painful lipomas have been reported to occur in any location, except in the head and the neck.[13]

◦Different types can be identified according to the spread of pain.

■Type I, or the juxta-articular type, with painful folds of fat on the inside of the knees and/or on the hips, in rare cases only evident in upper-arm fat

■Type II, or the diffuse, generalized type, where widespread pain from fatty tissue is found, apart from that of type I, also often in the dorsal upper-arm fat, in the axillary and gluteal fat, in the stomach wall, in dorsal fat folds, and on the soles of the feet

■Type III, or the lipomatosis, nodular type, with intense pain in and around multiple lipomas, sometimes in the absence of general obesity; lipomas are approximately 0.5-4 cm, soft, and attached to the surrounding tissue (Histologically, these are not always encapsulated. Some have been classified as angiolipomas.)

•Type of pain

◦The pain varies from discomfort on palpation to excruciating, paroxysmal spontaneous attacks.[3]

◦The pain can be aching, burning, or stabbing, often described by the patient as "it hurts everywhere."

◦The pain is usually symmetrical; however, it can become localized to the thighs, the knees, or the upper extremities.

◦Pain can be felt in the skeletal system and in the fat.

•Hyperalgesia is found by light pressure and touch in the fatty tissue below the skin and is made worse by tightly fitting clothes or showering. The pain is temperature and weather dependent; it decreases in dry heat and when pressure is high. Hot baths can have a positive but short-term effect in the relief of pain, but some patients do not tolerate heat. Estrogen replacement at menopause does not reduce the pain.

•Other symptoms, with variable incidence, include the following:

◦The fingers have a tendency to swell up, fumble, and tingle, and they can be numb (paresthesias), in addition to secondary median nerve compression.

◦General tiredness similar to the symptoms of chronic fatigue syndrome may be present. Light physical activity and poor sleep aggravate the tiredness.

◦A tendency to bruise, possibly secondary to the formation of delicate vessels in fat deposits, may be present. Coagulation test results are normal.

◦Morning stiffness and stiffness after resting may occur.

◦Headaches (eg, tension headaches, classic migraine, neck headaches) may occur. Also, pain in the jaw and the eyes due to retrobulbar fatty tissue may be present.

◦Cognitive dysfunction, with concentration and memory problems, may be present.

◦Bouts of depression (atypical depression, possibly latent) may occur; this finding is not associated with the onset of the disease.

◦Feeling hot affects a small number of patients, with recurring high temperatures of 37.5-39°C for weeks at a time associated with worsening of pain.

◦Patients may become susceptible to infection, which is possibly due to the presence of fat. Pain is exacerbated with infections.

Next Section: Physical PhysicalDercum disease (adiposis dolorosa) symptoms are almost always out of proportion to the physical findings, which include the following:

•Dercum disease (adiposis dolorosa) patients are usually 50% over the normal weight for their age. In some patients, only localized fat, without general obesity, is present.

•Lipomas are multiple, painful, symmetrically distributed, fatty deposits that are either diffuse or localized. The abdominal region and the lower extremities are common sites, especially around the knees. The ankle is an uncommon site of involvement.[14]

•Hyperalgesia is found in the fatty tissue below the skin on light pressure and touch.

•Other findings include acral swelling, bruises, and telangiectasias.


05/25/2011 05:00 PM

Wow this is a very good article! Me likey!


05/25/2011 06:05 PM

There are multiple pages to it on the web site. I think it is my favorite site. Very thorough and easy to understand.

05/25/2011 08:45 PM
Posts: 43
New Member

WOW Diane,

I like. What is the web site, Did I miss it?Oh yeah, it's Emedicine. I guess I did miss it. Not feeling well and not thinking well. Who would know...

Miss Betty

05/26/2011 05:58 AM

Sorry to hear that, Betty. Sad I think this rainy, stormy weather is just killing us! And I am soooo sick of it!

If you need the link to the site, it is



05/26/2011 02:24 PM
Posts: 43
New Member

Thanks Diane

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