RESUMO
Both lipedema and juxta-articular adiposis dolorsa are painful disorders of subcutaneous adipose tissue. We investigated 297 female patients with lipedema treated at our department for the presence of juxta-articular adiposis dolorsa. Occurrence of both disorders was identified in 4.4% of lipedema patients. The common presence of both disorders was observed only in more advanced lipedema (grade II and III). Juxta-articular adiposis dolorosa of the knees is seen exclusively on the inner knees, and it presents neither bruising nor creases or hypothermia. Choices of surgical treatment are either microcannula liposuction or dermolipectomy. Recurrences have not been observed.
Assuntos
Adipose Dolorosa , Lipedema , Adipose Dolorosa/complicações , Adipose Dolorosa/diagnóstico , Adipose Dolorosa/epidemiologia , Feminino , Humanos , Lipedema/diagnóstico , Lipedema/epidemiologia , Lipedema/cirurgiaAssuntos
Adipose Dolorosa/tratamento farmacológico , Carbazóis/administração & dosagem , Drogas em Investigação/administração & dosagem , Dor/tratamento farmacológico , Gordura Subcutânea/efeitos dos fármacos , Adipose Dolorosa/complicações , Carbazóis/efeitos adversos , Drogas em Investigação/efeitos adversos , Feminino , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Resultado do TratamentoAssuntos
Adipose Dolorosa/metabolismo , Lipomatose/metabolismo , Doenças Raras/metabolismo , 1-Alquil-2-acetilglicerofosfocolina Esterase/sangue , Adipose Dolorosa/complicações , Adipose Dolorosa/diagnóstico por imagem , Proteína C-Reativa , Criança , HDL-Colesterol/sangue , Dislipidemias/sangue , Feminino , Humanos , Lipomatose/diagnóstico , Lipoproteínas/sangue , Dor/etiologia , Doenças Raras/complicações , Doenças Raras/diagnóstico por imagemAssuntos
Humanos , Feminino , Criança , Adipose Dolorosa/metabolismo , Doenças Raras/metabolismo , Lipomatose/metabolismo , Dor/etiologia , Proteína C-Reativa , Adipose Dolorosa/complicações , Adipose Dolorosa/diagnóstico por imagem , Doenças Raras/complicações , Doenças Raras/diagnóstico por imagem , 1-Alquil-2-acetilglicerofosfocolina Esterase/sangue , Dislipidemias/sangue , Lipomatose/diagnóstico , Lipoproteínas/sangue , HDL-Colesterol/sangueRESUMO
The cutaneous manifestations of obesity and the associated metabolic syndrome (MetS) may present with a wide variety of cutaneous findings, including acanthosis nigricans, acrochordon, cellulitis, psoriasis, hidradenitis suppurativa, acne, and hirsutism. Being aware of such clinical signs and the underlying systemic disorders may facilitate earlier diagnoses, thereby permitting earlier of therapy initiation and prevention of long-term sequelae. In this process, dermatologists are key figures in the early detection of MetS and its clinical manifestations.
Assuntos
Síndrome Metabólica/complicações , Obesidade/complicações , Dermatopatias/complicações , Acantose Nigricans/complicações , Adipose Dolorosa/complicações , Celulite/complicações , Dermatite Seborreica/complicações , Gota/complicações , Hidradenite Supurativa/complicações , Hirsutismo/complicações , Humanos , Hiperandrogenismo/complicações , Líquen Plano/complicações , Psoríase/complicações , Xantomatose/complicaçõesAssuntos
Adipose Dolorosa/complicações , Doenças do Sistema Nervoso/etiologia , Adipose Dolorosa/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Saúde da Família , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico por imagemRESUMO
OBJECTIVE: Investigational, near-infrared fluorescence (NIRF) lymphatic imaging was used to assess lymphatic architecture and contractile function in participants diagnosed with Dercum's disease, a rare, poorly understood disorder characterized by painful lipomas in subcutaneous adipose tissues. METHODS: After informed consent and as part of an FDA-approved feasibility study to evaluate lymphatics in diseases in which their contribution has been implicated, three women diagnosed with Dercum's disease and four control subjects were imaged. Each participant received multiple intradermal and subcutaneous injections of indocyanine green (ICG, total dose ≤400 µg) in arms, legs, and/or trunk. Immediately after injection, ICG was taken up by the lymphatics and NIRF imaging was conducted. RESULTS: The lymphatics in the participants with Dercum's disease were intact and dilated, yet sluggishly propelled lymph when compared to control lymphatics. Palpation of regions containing fluorescent lymphatic pathways revealed tender, fibrotic, tubular structures within the subcutaneous adipose tissue that were associated with painful nodules, and, in some cases, masses of fluorescent tissue indicating that some lipomas may represent tertiary lymphoid tissues. CONCLUSIONS: These data support the hypothesis that Dercum's disease may be a lymphovascular disorder and suggest a possible association between abnormal adipose tissue deposition and abnormal lymphatic structure and function.
Assuntos
Adipose Dolorosa/complicações , Adipose Dolorosa/patologia , Doenças Linfáticas/etiologia , Doenças Linfáticas/patologia , Gordura Subcutânea/patologia , Feminino , Humanos , Verde de Indocianina , Raios Infravermelhos , Sistema Linfático/patologia , Pessoa de Meia-Idade , Imagem Óptica , Dor , FenótipoRESUMO
In this case report, we describe a patient with Dercum's disease who was successfully managed with metformin. The administration of metformin reduced pain intensity from 9/10 to 3/10 and favorably affected the profile of inflammatory cytokines (i.e., TNF a, IL-1ß, IL-6, and IL-10), adipokines (i.e., adiponectin, leptin, and resistin), and ß-endorphin. Because each variable was affected moderately by the drug, in the range of 20 - 30%, it follows that these effects are additive, i.e., they act independently of each other. However, taking into account advances in the pharmacology of metformin, it seems that other phenomena, such as modulation of synaptic plasticity, activation of microglia, and autophagy of the afferents supplying painful lipomas should be taken into consideration. Nonetheless, metformin deserves further exploration in the biology of pain.
Assuntos
Adipose Dolorosa/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Neuralgia/tratamento farmacológico , Manejo da Dor/métodos , Adipose Dolorosa/complicações , Adipose Dolorosa/imunologia , Citocinas/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/imunologia , Humanos , Hipoglicemiantes/administração & dosagem , Masculino , Metformina/administração & dosagem , Pessoa de Meia-Idade , Neuralgia/etiologia , Neuralgia/imunologia , Resultado do TratamentoRESUMO
BACKGROUND: Dercum's disease is characterised by pronounced pain in the adipose tissue and a number of associated symptoms. The condition is usually accompanied by generalised weight gain. Many of the associated symptoms could also be signs of depression. Depression in Dercum's disease has been reported in case reports but has never been studied using an evidence-based methodology. The aim of this study was to examine the presence of depression in patients with Dercum's disease compared to obese controls that do not experience any pain. METHODS: A total of 111 women fulfilling the clinical criteria of Dercum's disease were included. As controls, 40 obese healthy women were recruited. To measure depression, the Montgomery Åsberg Depression Rating Scale (MADRS) was used. RESULTS: According to the total MADRS score, less than half of the patients were classified as having "no depression" (44%), the majority had "light" or "moderate depression" (55%) and one individual had "severe depression" in the Dercum group. In the control groups, the majority of the patients were classified as having "no depression" (85%) and a small number had "light depression" (15%). There was a statistically significant difference for the total MADRS score between the two groups (p = 0.014). CONCLUSION: The results indicate that the patients with Dercum's disease are more likely to suffer from depression than controls.
Assuntos
Adipose Dolorosa/complicações , Transtorno Depressivo/complicações , Obesidade/complicações , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The aim of this prospective study is to assess the effect of liposuction on the pain experienced by women with Dercum's disease (adiposis dolorosa). DESIGN: Pain was examined preoperatively and at 3 months, and 1, 2, 3, and 5 years after liposuction. The subjective pain sensation was evaluated with a visual analog scale and number of words chosen, and the objective pain sensation with the mechanical pressure pain threshold. SETTING: Dercum's disease is characterized by obesity and pronounced pain in the adipose tissue. The pain is chronic and often disabling and resistant to traditional analgesics and other pain treatment. However, five reports have been published on the encouraging effect of liposuction. PATIENTS: Pain was evaluated in 53 patients with Dercum's disease that had been operated on with liposuction. As controls, 58 nonoperated subjects with Dercum's disease and 41 obese abdominoplasty patients were followed for 5 years. RESULTS: Both subjective and objective pain measurements revealed a statistically significant decrease in the pain experienced by the Dercum patients after surgery as compared with preoperatively. However, the pain relief diminished over time. Furthermore, a significant postoperative difference could be seen between the Dercum operated group and the Dercum controls as regards measured pain. The difference decreased over time but still lingered 5 years postoperatively. CONCLUSION: The results suggest that liposuction might alleviate pain in patients with Dercum's disease. However, it is difficult to determine whether the effect is due to the actual surgery or to other factors.
Assuntos
Adipose Dolorosa/complicações , Adipose Dolorosa/cirurgia , Lipectomia , Dor/etiologia , Dor/cirurgia , Tecido Adiposo/fisiopatologia , Tecido Adiposo/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Obesidade/cirurgia , Medição da Dor , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
A 46-year-old female, known case of adiposis dolorosa since adolescence, noticed painful thickening of scalp in bilateral parieto-occipital areas and vertex 1 year back. Six weeks prior to the presentation to our service, she developed severe occipital headache refractory to drug treatment. She improved after bilateral greater occipital nerve blocks. She was subjected to bilateral greater occipital chemical neurolysis which has given her complete pain relief.
Assuntos
Adipose Dolorosa/diagnóstico , Transtornos da Cefaleia/diagnóstico , Neuralgia/diagnóstico , Couro Cabeludo/inervação , Adipose Dolorosa/complicações , Adipose Dolorosa/patologia , Diagnóstico Diferencial , Feminino , Transtornos da Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Neuralgia/tratamento farmacológico , Neuralgia/patologia , Couro Cabeludo/patologia , Nervos Espinhais/efeitos dos fármacos , Nervos Espinhais/patologiaAssuntos
Adipose Dolorosa/complicações , Adipose Dolorosa/diagnóstico , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Asma/tratamento farmacológico , Espaço Epidural , Feminino , Humanos , Hipestesia/etiologia , Perna (Membro) , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Parestesia/etiologia , Prednisolona/efeitos adversos , Prednisolona/uso terapêuticoRESUMO
Among the symptoms reported by patients undergoing breast imaging, pain is one of the most common. Mastalgia is generally classified as cyclic, noncyclic, or extramammary. A rare cause of breast pain is Dercum's disease, or adiposis dolorosa, a condition characterized by multiple, often painful subcutaneous lipomas. Painful breast lipomas have not been described in the literature so far. The diagnosis is made by clinical means supported by diagnostic imaging. We report the case of a 58-year-old postmenopausal woman affected by Dercum's disease in the breast. Ultrasound examination showed multiple oval, well-defined, hyperechoic lesions suggestive of breast lipomas. No significant features were detected by mammography.
Assuntos
Adipose Dolorosa/complicações , Adipose Dolorosa/diagnóstico , Doenças Mamárias/complicações , Doenças Mamárias/diagnóstico , Dor/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Lipoma/complicações , Lipoma/diagnóstico , Mamografia , Pessoa de Meia-Idade , Ultrassonografia MamáriaRESUMO
Dercum's disease which is also termed lipomatosis dolorosa is a rare and relatively unknown disease. In this entity the upper arms, elbows, stomach wall, buttocks, thighs and knees are predominantly affected showing painful subcutaneous adipose tissue deposits. In addition severe hyperalgesia can be triggered by light pressure and touch. Analgesic and/or nonsteroidal antirheumatic drugs have usually only a minor or no effect. Here, we report a patient with Dercum's disease who was successfully treated with pregabalin and manual lymphatic drainage, and present a current overview of the literature.
Assuntos
Adipose Dolorosa/terapia , Analgésicos/uso terapêutico , Linfedema/terapia , Sucção/métodos , Ácido gama-Aminobutírico/análogos & derivados , Tecido Adiposo/patologia , Adipose Dolorosa/complicações , Adipose Dolorosa/patologia , Feminino , Humanos , Hiperalgesia/tratamento farmacológico , Hiperalgesia/etiologia , Hiperalgesia/patologia , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Pregabalina , Resultado do Tratamento , Ácido gama-Aminobutírico/uso terapêuticoAssuntos
Dor Abdominal/etiologia , Adipose Dolorosa/complicações , Dor Abdominal/tratamento farmacológico , Parede Abdominal , Adipose Dolorosa/diagnóstico , Adipose Dolorosa/tratamento farmacológico , Anestésicos Locais/administração & dosagem , Doença Crônica , Diagnóstico Diferencial , Humanos , Infusões Intravenosas , Lidocaína/administração & dosagemRESUMO
HISTORY AND CLINICAL FINDINGS: A 63-year-old woman was admitted because of abdominal pain for 12 months, associated with an increasing abdominal distension. One month before a gastroscopy had revealed mild gastritis. The taking of proton pump inhibitors did not improve her symptoms. There was no relevant neurological or psychiatric past history. INVESTIGATIONS: Ultrasound and laboratory tests demonstrated a fatty liver and increased serum levels of lipoproteins. Magnetic resonance imaging revealed an increase in subcutaneous and intraperitoneal adipose tissue. Endoscopy did not show any additional significant findings. DIAGNOSIS AND TREATMENT: The patient had adiposis dolorosa. Initially she was given daily a combination of mexiletine 400 mg and 75 mg Amitriptyline. After a few days the ailment decreased and had disappeared completely after one week. Three months later the dosage was reduced to 100 mg mexiletine and 25 mg Amitriptyline daily. After another two months all medication was discontinued. At follow-up after 12 months the symptoms had not recurred. CONCLUSION: This case demonstrates that abdominal pain is not always caused by diseases of the visceral hollow organs. It must also be borne in mind that abdominal pain may be associated with adipose tissue, as is the case in adiposis dolorosa. The disease can be successfully treated, as in this case, using a combination of mexiletine and Amitriptyline.
Assuntos
Dor Abdominal/etiologia , Adipose Dolorosa/diagnóstico , Adipose Dolorosa/tratamento farmacológico , Amitriptilina/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Mexiletina/uso terapêutico , Dor Abdominal/tratamento farmacológico , Adipose Dolorosa/complicações , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/tratamento farmacológico , Recidiva , Resultado do TratamentoRESUMO
Dercum's disease or adiposis dolorasa is unusual and unknown. Four symptoms are typical. It is characterized by painful subcutaneous fatty tumors in postmenopausal woman. We present this disease through the study of an uncommon clinical case: a sceptic choc following the "steato-cutaneous-necrosis" of a fatty tumor. The disease remains rare. The etiology is to this day unknown and different hypothesis (endocrinous, metabolic, genetics) are put forward. Multiple complications can occur but severe septicemia is rare. The treatment can be medical (loss of weight, corticoids, intravenous lidocaine) or surgical (surgical excision or liposuction).