Subcutaneous adipose tissue therapy reduces fat by dual X-ray absorptiometry scan and improves tissue structure by ultrasound in women with lipoedema and Dercum disease.
Lipoedema is painful nodular subcutaneous adipose tissue (SAT) on legs and arms of women sparing the trunk. People with Dercum disease (DD) have painful SAT masses. Lipoedema and DD fat resists loss by diet and exercise. Treatments other than surgery are needed. Six women with lipoedema and one with DD underwent twelve 90‐min sessions over 4 weeks. Body composition by dual X‐ray absorptiometry scan, leg volume, weight, pain, bioimpedance, tissue size by caliper and ultrasound were analysed before and after SAT therapy by paired t‐tests. There was a significant decrease from baseline to end of treatment in weight, 87.6 ± 21 to 86.1 ± 20.5 kg (P = 0.03), leg fat mass 17.8 ± 7.7 to 17.4 ± 7.6 kg (P = 0.008), total leg volume 12.9 ± 4 to 12 ± 3.5 L (P = 0.007), six of 20 calliper sites and tissue oedema. Pain scores did not change significantly. By ultrasound, six women had 22 hyperechoic masses in leg fat that resolved after treatment; five women developed seven new masses. Fascia improved by ultrasound after treatment. SAT therapy reduced amount and structure of fat in women with lipoedema and Dercum disease; studies are needed to compare SAT therapy to other therapies.
Adiposis dolorosa is a rare disorder of multiple painful subcutaneous growths of adipose tissue. It is also known as Dercum disease, Ander syndrome, morbus Dercum, adipose tissue rheumatism, adiposalgia, or lipomatosis dolorosa. This disease was first discovered in the late 1800s by American neurologist Francis Xavier Dercum. It is classified into 4 types which include generalized diffuse, generalized nodular, localized nodular, and juxta-articular forms. The generalized diffuse type presents with widespread painful adipose tissue with no apparent lipomas. The generalized nodular type presents with widespread, painful adipose tissue that is more painful in the vicinity of lipomas. In the localized nodular type, the pain is restricted to areas within and around lipomas. Lastly, the juxta-articular type presents as painful solitary adipose tissue near large joints. The diagnosis of adiposis dolorosa is made clinically and is a diagnosis of exclusion. The proposed criteria for the diagnosis includes chronic pain of the subcutaneous tissue for over 3 months in overweight or obese patient, though the criteria still need to be validated. The pain is often disabling and resistant to treatment. The disease is associated with weakness and psychiatric symptoms such as depression. Other associated symptoms include fatty deposits, easy bruising, sleep disturbances, impaired memory, difficulty concentrating, anxiety, rapid heartbeat, shortness of breath, diabetes, bloating, constipation, fatigue, and joint pain.
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We present a case of a 39-year-old man who presented with chronic bilateral upper extremity pain associated with innumerable angiomyolipomas that developed 5 years after a motor vehicle accident involving his upper extremities. Our case notes the rare nature of painful adipose tissue deposits and the diagnostic challenges.
BMJ Case Reports 2018; doi:10.1136/bcr-2017-223869
This document is in German. Google Translate was used on the following paragraphs.
In the case of lipomatosis dolorosa, generalized and diffuse painful subcutaneous adipose tissue tumors occur. Mainly obese women are affected; the incidence peak is between the ages of 35 and 50, often after the menopause. The rare disease was in the year First described in 1892 by Francis Xavier Dercum, an American doctor. More detailed data on epidemiology are not yet available, so that the current literature is limited to individual cases and smaller case series.
The previously suspected endocrine or neuronal dysfunctions did not stand up to review in studies. Likewise, no clear evidence of disturbances in fatty acid metabolism or an increased “level of inflammation” was found. There were no significant differences in the concentration of tumor necrosis factor (TNF) -α, interleukin (IL) in ten patients with Dercum disease compared to an age, BMI, body fat mass and weight-adjusted female control cohort. 1β, IL-8, IL-10, CC chemokine ligand (CCL) 3, leptin or adiponectin. Even the earlier hypothesis that the genesis is traumatically induced can not be substantiated by the few case reports published in this regard.
In a study from 2014 with indocyanine green visualization of the lymphoid pathways by near infraRed fluorescence (NIRF) videography in three patients with Dercum disease, delayed lymphatic drainage was detected in the dilated lymphatics of the lipomas. The mutation of mitochondrial DNA described in BSL has not been proven in Dercum disease.
Full text PDF here: https://onlinelibrary.wiley.com/doi/abs/10.1111/ddg.13460_g
• D-amphetamine anecdotally improves the painful fat/lymphatic disorder, Dercum’s disease.
• Two patients with Dercum’s disease were treated with d-amphetamine to improve lymphatic function through the sympathetic nervous system.
• Both patients lost weight, and fatty liver in a man and liver lipomas in a woman resolved in less than a year on ≤20 mg of D-amphetamine daily.
• Low dose d-amphetamine may improve fatty liver and Dercum’s disease.
Dercum disease is a rare disorder of painful subcutaneous adipose tissue masses typically presenting as a constellation of signs and symptoms affecting most organs including slow lymphatic flow and fatty liver.
The University of Arizona Institutional Review Board considered this report exempt after patient consent. Multislice, multisequence magnetic resonance imaging (MRI) of the abdomen and pelvis was performed before and after d-amphetamine, with and without intravenous gadolinium.
Initial MRI demonstrated hepatic steatosis in Case 1; Case 2 had two-subcentimeter lipid foci within the liver. Initiation of 10-20 mg d-amphetamine decreased liver lipid deposition from 16% to 4% in Case 1 and resolved fat deposits in Case 2 after ~one year.
There is a dire need for novel treatment options for non-alcoholic fatty liver disease to prevent progression to cirrhosis. Reduction of liver fat by d-amphetamine suggests a potential therapeutic role in non-alcoholic fatty liver disease.
S. Ghazala, J. Bilal, E. Ross, B. Kalb, I.B Riaz, K.L. Herbst