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  • Original Article
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Clinical Studies and Practice

Differentiating lipedema and Dercum’s disease

International Journal of Obesity volume 41, pages 240–245 (2017)Cite this article

Subjects

Abstract

Background:

People with lipedema or Dercum’s disease (DD) can have a similar distribution of excess painful nodular subcutaneous adipose tissue (SAT), making them difficult to differentiate.

Methods:

Case series of 94 patients with DD, 160 with lipedema and 18 with both diagnoses (Lip+DD) from a single clinic in an academic medical center to improve identification and differentiation of these disorders by comparison of clinical findings, prevalence of type 2 diabetes (DM2), hypermobility by the Beighton score and assessment of a marker of inflammation, Total complement activity (CH50).

Results:

Differences between groups were by Student’s t-test with α of 0.05. The Lipedema Group had significantly greater weight, body mass index (BMI), gynoid distributed nodular SAT and fibrotic and heavy tissue than the DD Group. Hypermobility was significantly higher in the Lipedema (58±0.5%) than DD Group (23±0.4%; P<0.0001). DM2 was significantly greater in the DD (16±0.2%; P=0.0007) than the Lipedema Group (6±0.2%). Average pain by an analog scale was significantly higher in the DD (6±2.5%) than the Lipedema Group (4±2.1%; P<0.0001). Fatigue and swelling were common in both groups. Easy bruising was more common in the Lipedema Group, whereas abdominal pain, shortness of breath, fibromyalgia, migraines and lipomas were more prevalent in the DD Group. The percentage of patients with elevated CH50 was significantly positive in both groups.

Conclusions:

The significantly lower prevalence of DM2 in people with lipedema compared with DD may be due to the greater amount of gynoid fat known to be protective against metabolic disorders. The high percentage of hypermobility in lipedema patients indicates that it may be a comorbid condition. The location of fat, high average daily pain, presence of lipomas and comorbid painful disorders in DD patients may help differentiate from lipedema.

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References

  1. Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al. Lipedema: an inherited condition. Am J Med Genet A 2010; 152A: 970–976.

    Article  Google Scholar 

  2. Cantu JM, Ruiz-Barquin E, Jimenez M, Castillo L, Macotela-Ruiz E . Autosomal dominant inheritance in adiposis dolorosa (Dercum's disease). Humangenetik 1973; 18: 89–91.

    CAS  PubMed  Google Scholar 

  3. Marshall M, Schwahn-Schreiber C . Prävalenz des Lipödems bei berufstätigen Frauen in Deutschland (Lipödem-3-Studie). Phlebologie 2011; 3: 127–134.

    Google Scholar 

  4. Beninson J, Edelglass JW . Lipedema—the non-lymphatic masquerader. Angiology 1984; 35: 506–510.

    Article  CAS  Google Scholar 

  5. Földi E, Földi M . Das Lipödem. In: Földi M, Földi E, Kubik S (eds). Lehrbuch der Lymphologie für Mediziner, Masseure und Physiotherapeuten. Elsevier, Urban&Fischer: Munich, 2005, pp 443–453.

    Google Scholar 

  6. Herbst KL . Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin 2012; 33: 155–172.

    Article  CAS  Google Scholar 

  7. Brorson H, Fagher B . [Dercum's disease. Fatty tissue rheumatism caused by immune defense reaction?]. Lakartidningen 1996; 93: 3–6.

    Google Scholar 

  8. Herbst KL, Asare-Bediako S . Adiposis dolorosa is more than painful fat. Endocrinologist 2007; 17: 326–344.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. Allen EV, Hines EAJ . Lipedema of the legs: a syndrome characterised by fat legs and orthostatic edema. Proc Staff Meet Mayo Clin 1940; 15: 184–187.

    Google Scholar 

  11. Fife CE, Maus EA, Carter MJ . Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Adv Skin Wound Care 2010; 23: 81–92, quiz 3-4.

    Article  Google Scholar 

  12. Herbst K, Mirkovskaya L, Bharhagava A, Chava Y, Te CH . Lipedema fat and signs and symptoms of illness, increase with advancing stage. Arch Med 2015; 7: 1–8.

    Google Scholar 

  13. Cornely M . Lipoedema of arms and legs. Part 2: conservative and surgical therapy of the lipoedema, lipohyper- plasia dolorosa. Phlebologie 2011; 40: 146–151.

    Article  Google Scholar 

  14. Dercum FX . A subcutaneous connective-tissue dystrophy of the arms and back, associated with symptoms resembling myxoedema. Univ Med Mag Philad 1888; 1: 140–150.

    Google Scholar 

  15. Lyon IP . Adiposis and lipomatosis considered in reference to their constitutional relations and symptomatology. Arch Intern Med 1910; VI: 28–120.

    Article  Google Scholar 

  16. Gossage AM . Adiposis dolorosa. Proc R S Med 1911; 4, (Clin Sect) 4–8.

    CAS  Google Scholar 

  17. Tins BJ, Matthews C, Haddaway M, Cassar-Pullicino VN, Lalam R, Singh J et al. Adiposis dolorosa (Dercum's disease): MRI and ultrasound appearances. Clin Radiol 2013; 25: 00199–2.

    Google Scholar 

  18. Petscavage-Thomas JM, Walker EA, Bernard SA, Bennett J . Imaging findings of adiposis dolorosa vs. massive localized lymphedema. Skeletal Radiol 2015; 13: 13.

    Google Scholar 

  19. Monnin-Delhom ED, Gallix BP, Achard C, Bruel JM, Janbon C . High resolution unenhanced computed tomography in patients with swollen legs. Lymphology 2002; 35: 121–128.

    CAS  PubMed  Google Scholar 

  20. Amann-Vesti BR, Franzeck UK, Bollinger A . Microlymphatic aneurysms in patients with lipedema. Lymphology 2001; 34: 170–175.

    CAS  PubMed  Google Scholar 

  21. Rasmussen JC, Herbst KL, Aldrich MB, Darne CD, Tan IC, Zhu B et al. An abnormal lymphatic phenotype is associated with subcutaneous adipose tissue deposits in Dercum's disease. Obesity 2014; 9: 20836.

    Google Scholar 

  22. Suga H, Araki J, Aoi N, Kato H, Higashino T, Yoshimura K . Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration. J Cutan Pathol 2009; 3: 3.

    Google Scholar 

  23. Herbst KL, Coviello AD, Chang A, Boyle DL . Lipomatosis-associated inflammation and excess collagen may contribute to lower relative resting energy expenditure in women with adiposis dolorosa. Int J Obes (Lond) 2009; 33: 1031–1038.

    Article  CAS  Google Scholar 

  24. Curri SB, Merlen JF . [Microvascular disorders of adipose tissue]. J Mal Vasc 1986; 11: 303–309.

    CAS  PubMed  Google Scholar 

  25. Kim JI, Huh JY, Sohn JH, Choe SS, Lee YS, Lim CY et al. Lipid-overloaded enlarged adipocytes provoke insulin resistance independent of inflammation. Mol Cell Biol 2015; 35: 1686–1699.

    Article  CAS  Google Scholar 

  26. Foldi E, Foldi M . Lipedema. In: Foldi M, Foldi E (eds). Foldi's Textbook of Lymphology. Elsevier GmbH: Munich, Germany, 2006, pp 417–427.

    Google Scholar 

  27. Vlaicu SI, Tatomir A, Boodhoo D, Vesa S, Mircea PA, Rus H . The role of complement system in adipose tissue-related inflammation. Immunol Res 2016; 11: 11.

    Google Scholar 

  28. Beighton P, Grahame R, Bird H. Assessment of hypermobility. In: Beighton P, Grahame R, Bird H (eds). Hypermobility of Joints. 4th edn. Springer: London, 2012, pp 11–26.

    Book  Google Scholar 

  29. Rimm AA, Hartz AJ, Fischer ME . A weight shape index for assessing risk of disease in 44,820 women. J Clin Epidemiol 1988; 41: 459–465.

    Article  CAS  Google Scholar 

  30. Te C, Herbst KL. Case Report: Lymphatic dysfunction in a patient with familial multiple angiolipomatosis. (submitted) 2015.

  31. Scheper MC, Juul-Kristensen B, Rombaut L, Rameckers EA, Verbunt J, Engelbert RH . Disability in adolescents and adults diagnosed with hypermobility related disorders: a meta-analysis. Arch Phys Med Rehabil 2016; 11: 00154–4.

    Google Scholar 

  32. Johannessen EC, Reiten HS, Lovaas H, Maeland S, Juul-Kristensen B . Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type. Disabil Rehabil 2016; 29: 1–9.

    Google Scholar 

  33. Malfait F, Wenstrup R, De Paepe A. et al. Ehlers-Danlos Syndrome, Classic Type [Updated 2011 Aug 18]. In Pagon RA, Adam MP, Ardinger HH (eds GeneReviews® [Internet]. University of Washington: Seattle, WA, USA 1993-2016 2007. Available from https://www.ncbi.nlm.nih.gov/books/NBK1244/.

    Google Scholar 

  34. Pascucci A, Lynch PJ . Lipedema with multiple lipomas. Dermatology 2010; 16: 4.

    Google Scholar 

  35. Watanabe A, Satoh K, Maniwa T, Matsumoto K . Proteomic analysis for the identification of serum diagnostic markers for joint hypermobility syndrome. Int J Mol Med 2016; 37: 461–467.

    Article  CAS  Google Scholar 

  36. Vlaicu SI, Tatomir A, Boodhoo D, Vesa S, Mircea PA, Rus H . The role of complement system in adipose tissue-related inflammation. Immunol Res 2016; 64: 653–664.

    Article  CAS  Google Scholar 

  37. van Greevenbroek MM, Ghosh S, van der Kallen CJ, Brouwers MC, Schalkwijk CG, Stehouwer CD . Up-regulation of the complement system in subcutaneous adipocytes from nonobese, hypertriglyceridemic subjects is associated with adipocyte insulin resistance. J Clin Endocrinol Metab 2012; 97: 4742–4752.

    Article  CAS  Google Scholar 

  38. Premalatha S, Sarveswari KN, Lahiri K. Reverse-Namaskar: a new sign in Ehlers-Danlos syndrome: a family pedigree study of four generations.

  39. Herbst KL . Lipedema. In: Zuther JE, Norton S (eds). Lymphedema Management: The Comprehensive Guide for Practitioners, 4th edn. Thieme: New York, NY, USA, 2017, in progress.

    Google Scholar 

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Acknowledgements

We thank all of the women and men with lipedema and Dercum’s disease whose data was used for this paper, and everyone who has encouraged us over the years.

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Authors and Affiliations

  1. College of Science, University of Arizona, Tucson, AZ, USA

    K Beltran

  2. Department of Medicine, Medical Imaging and Pharmacy, University of Arizona, Tucson, AZ, USA

    K L Herbst

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Correspondence to K L Herbst.

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Beltran, K., Herbst, K. Differentiating lipedema and Dercum’s disease. Int J Obes 41, 240–245 (2017). https://doi.org/10.1038/ijo.2016.205

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