The characteristic finding of Dercum’s disease is the formation of multiple, painful growths consisting of fatty tissue (lipomas) that are found just below the surface of the skin but also deep. Lipomas in people with Dercum’s disease may be found in any part of the body, although they are rare in the head, neck, hands and feet. The trunk, upper arms and upper legs are most often affected. The lipomas can be the size of a pea or as large as a grape, plum or fist. Dercum’s disease may occur in one or more people in a family with familial multiple lipomatosis (FML Type), may occur due to angiolipomas which are known to be painful (angiolipoma type) or may occur as small diffuse (widespread) pea-sized or larger lipomas anywhere in subcutaneous fat tissue especially over the ribs and including around joints due to the presence of Inflammation in the body from any cause (healing disorder type). Pain may vary from mild discomfort when a growth is pressed or touched to severe Pain that is disproportionate to the physical findings; Pain must be present for at least three months. Some affected individuals feel that “all fat hurts.” Pain can last for hours and may come and go or last continuously. In severe cases, Pain may worsen with movement. Many people with Dercum’s disease describe exacerbations or “flares” of Pain that may be accompanied by worsening of symptoms such as Fatigue and “brain fog”. The exact reason for Pain associated with Dercum’s disease is unknown but may occur because the lipomas press on nearby nerves or because the fascia is inflamed. The lipomas associated with Dercum’s disease have more connective tissue than non Dercum’s disease fat. Connective tissue (fascia) in fat has more Pain sensors than muscle, for example, and when tight or inflamed, can cause Pain as in fibromyalgia. Fibromyalgia is not uncommon in people with Dercum’s disease.
Some individuals with Dercum’s may experience Swelling of various areas of the body, especially the hands, but often one arm or leg may be swollen and therefore more painful. Swelling occurs for no apparent reason, though on imaging, the lymphatic system can be slow to pump in the painful limb compared to the less painful limb, or frank lymphedema may be present. The Pain may disappear without treatment but any manual therapy such as massage or manual lymphatic drainage can help. Significant weight gain is a common occurrence for most individuals affected by Dercum’s disease and needs to be treated to avoid progression to pre-diabetes or diabetes.
Additional symptoms may occur in individuals with Dercum’s disease including fatigue, generalized weakness, a tendency to bruise easily, headaches, irritability, and Stiffness after resting, especially in the morning, gastrointestinal symptoms, palpitations and shortness of breath. An association with bouts of depression, memory or concentration problems, anxiety, and a susceptibility to infection has been noted in some cases.
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 thyroid that is characterized by dry skin, Swelling around the lips and nose, mental deterioration and infection.