Familial Multiple Lipomas

This is a condition in which groups of fat cells in the subcutaneous tissues begin to grow spontaneously and produce multiple fatty lumps underneath the skin. These are benign fatty tumors or lipomas. This condition is quite common and is frequently genetic in origin, due to a mutation of the mitochondrial DNA. The presentation of this disease is variable. Most patients have multiple small fatty subcutaneous nodules that are painless. The number of nodules may vary from very few to many. They are mostly located on the arms, forearms, legs and trunk but they can occur in the neck, face and buttocks. In some patients, if neglected, these fatty lumps can grow to a large size and can make the patient appear grotesque. While these lumps are usually painless, in some patients they are painful and if large, they are subcategorized into an entity called Dercum’s Disease. This disease was first described by Dr. F. X. Dercum in 1888, when he found a patient with large painful subcutaneous tumors. The correct medical term is called Adiposis Dolorosa. In this aspect of familial multiple lipomatosis, the fatty lumps are painful. The degree of pain varies from being mild to severe. The cause of the pain is unknown. It has been reported to respond to intravenous lidocaine and oral mexiletine. Both these drugs are used to treat irregular heartbeats and how they reduce the pain is unknown. More recently, it was discovered that interferon alfpha-2b at low doses can relieve pain for a long time. The size of the lipomas was not affected. Sinequan, an antidepressant, has been reported to help. Some patients with Adiposis Dolorosa are obese and have depression so they might benefit from treating the depression. Since it is a disease that is seldom fatal, very little research is being done. Another variation of this disease is called Madelung’s Disease. This group of patients, as well as having multiple subcutaneous lumps, will also get these fatty lumps in places that disrupt function of some organs, like the larynx, the esophagus, the intestine, the lungs or the heart. The lumps are usually not painful. When any of these lumps get so large that they become unsightly, then they can be removed surgically or they can be treated with liposuction. Most of these lumps will grow back and may have to be removed repeatedly. These fatty lumps seldom become malignant. When they do change into malignant lipomas, they grow more rapidly and when continuous growth occurs in any one lump, that lipoma should be removed and examined pathologically. Dercum’s disease and Madelung’s disease are now becoming more recognized and more research will be done in the future. Some physicians believe that patients with these diseases have an increased incidence of cancer. There have been no large studies done to prove this but patients with cancer seem to have an increased incidence of these subcutaneous nodules. If you need more information about this rather common condition, please call my office for an appointment and I will be happy to discuss, clarify and manage your condition.