Introduction

What is Dercum’s Disease?

Dercum’s Disease, also known as adiposis dolorosa, is a rare condition characterised by the growth of multiple painful, fatty lumps (called lipomas) predominantly under the skin, often on the trunk and limbs. People with Dercum’s Disease may experience chronic pain, fatigue, and sometimes other symptoms like swelling or cognitive difficulties. The cause is not fully understood, but it is most often seen in adults, especially women, and can have a wide impact on daily life.¹

Why is it Important to Discuss Comorbidities?

Discussing comorbidities - other health conditions that often occur alongside Dercum’s disease is essential because these additional problems can complicate diagnosis, management, and quality of life. Dercum’s Disease has been linked with conditions such as obesity, diabetes, and various autoimmune disorders. These comorbidities may share underlying mechanisms, contribute to increased pain or disability, or require special care considerations. Understanding these connections helps patients and healthcare providers develop better, individualised treatment strategies and improves overall outcomes.² 

Understanding Dercum’s Disease

Main Symptoms and How It’s Diagnosed

Dercum’s Disease is defined by the presence of multiple, painful fatty growths (lipomas) beneath the skin, most commonly on the trunk, upper arms and upper legs. The pain can be mild or extremely severe, often lasting for months and sometimes worsening with movement or touch. Other symptoms include:

• Fatigue
• Weakness
• Sleep disturbances 
• Brain fog
• Depression
• Anxiety
• Swelling
• Easy bruising

Diagnosis is based on clinical evaluation, typically in adults who have generalised obesity and chronic pain in adipose tissue for more than three months. There are several subtypes, depending on how the pain and lipomas present. 

Who tends to get Dercum’s Disease?

Dercum’s Disease most often affects women, especially those aged 35-50 and who are overweight or obese. While it is up to 20 times more common in women, it can also occur in men and people who are not obese. Children are rarely affected. The exact cause is unknown, but possible risk factors include family history, hormonal changes and immune or metabolic disturbances.³

Common Misconceptions

Dercum’s Disease is sometimes mistaken for conditions like fibromyalgia or lipedema because of overlapping symptoms such as chronic pain and swelling. Another misconception is that weight loss will cure the disease, but the painful lipomas and symptoms often persist even with weight reduction. Additionally, some think it is just “benign” lipomas, but unlike typical lipomas, those in Dercum’s are typically very painful and resistant to standard treatment. Finally, the rarity and lack of awareness about Dercum’s Disease can lead to misdiagnosis. 

Dercum’s Disease and Obesity

What is Obesity?

Obesity is a medical condition characterised by excess body fat that can negatively impact health. It is commonly measured using the body mass index (BMI), where a BMI of 30 or above is classified as obese. Obesity increases the risk for many other health problems, such as diabetes, heart disease, and certain cancers.

How does Obesity relate to Dercum’s Disease?

Most people diagnosed with Dercum’s Disease are either overweight or obese. While the exact relationship is not fully understood, research suggests that the accumulation of excess fatty tissue may play a role in the development and severity of painful lipomas associated with the disease. Obesity may also worsen chronic inflammation in the body and can make the pain and other symptoms of Dercum’s Disease more severe. However, Dercum’s can also occur in people of normal weight, indicating that other factors are likely involved in its development. 

Challenges in Managing Weight

Managing weight with Dercum’s Disease can be particularly difficult. The chronic pain and fatigue make physical activity challenging for many patients. Swelling, depression, and sleep problems can also contribute to weight gain or make weight loss harder. Furthermore, while healthy eating and movement remain important, weight loss alone often does not resolve the painful lipomas or end the disease’s symptoms. This makes a supportive, multidisciplinary approach - including medical, nutritional, and psychological care, especially important for those affected. 

Links With Diabetes

What is Diabetes (Type 1 & Type 2)?

Diabetes is a chronic metabolic condition where the body cannot properly regulate blood sugar (glucose) levels. In type 1 diabetes, the immune system mistakenly attacks the pancreas, destroying the cells that produce insulin - this often begins in children or young adults and requires lifelong insulin replacement. Type 2 diabetes, more common in adults, happens when the body does not use insulin efficiently or does not make enough. Both can lead to serious complications like heart disease, nerve damage and kidney problems.⁴

Are people with Dercum’s Disease at greater risk?

Obesity is common in Dercum’s Disease and is a major risk factor for developing type 2 diabetes. Additionally, some research suggests metabolic changes and chronic inflammation associated with Dercum’s Disease may further increase the risk for diabetes. Reports also indicate that patients with Dercum’s Disease are often diagnosed with prediabetes or diabetes, highlighting the importance of monitoring blood sugar levels in this group. 

How Diabetes Can Affect Symptoms or Treatment?

Diabetes can worsen symptoms in people with Dercum’s Disease by contributing to nerve pain, poor wound healing, and increased inflammation. Managing diabetes effectively is especially important, as high blood sugar may worsen pain, fatigue and risk for infections. Some diabetes medications, like metformin, have shown promise in reducing pain and improving metabolic function in Dercum’s Disease patients, but individualised care is always needed.⁵ 

Autoimmune Disorders and Dercum’s Disease

What are Autoimmune Disorders?

Autoimmune disorders occur when the body’s immune system mistakenly attacks its own healthy tissues, triggering chronic inflammation and damage. Examples include rheumatoid arthritis, lupus, and autoimmune thyroid disease. 

Examples Commonly Seen with Dercum’s Disease 

People with Dercum’s Disease often report other autoimmune problems alongside their condition, including hypothyroidism (underactive thyroid), lupus, and rheumatoid arthritis. Some experts believe Dercum’s disease itself may have autoimmune features, where the immune system contributes to the chronic pain and swelling. 

How Immune Problems May Play a Role

Immune system dysfunction may increase inflammation, alter fat metabolism, and impact pain signalling in Dercum’s Disease. The presence of autoimmune disorders can worsen symptoms, complicate diagnosis and affect treatment responses, making immune health a focus in ongoing research and care.

Managing Dercum’s Disease and Its Comorbidities 

Lifestyle Changes: Diet, Physical Activity, Self-care

A healthy diet and regular movement help reduce inflammation, support weight control, and improve energy levels. Anti-inflammatory foods, gentle exercise, and stress management are central to living well with Dercum’s Disease. Self-care routines that address pain, sleep, and emotional health can also make daily life easier. 

Medical Treatments and Therapies

Common treatments include pain-relieving medications, physical therapy, and sometimes surgery to remove painful lipomas. Alternative approaches, such as acupuncture, may help with pain. Other therapies might target comorbidities like diabetes or thyroid diseases for a holistic strategy. 

Frequently Asked Questions

Is Dercum’s Disease Inherited?

Most cases of Dercum’s Disease occur without a clear family history. However, reports are suggesting that the disease can sometimes run in families, indicating a possible genetic predisposition, but no specific gene has been identified yet.

Can it Be Cured?

Currently, there is no known cure for Dercum’s Disease. Treatment focuses on relieving symptoms such as pain, improving quality of life, and managing associated conditions like obesity and diabetes. Some patients may experience periods of improvement, but most require ongoing care. 

Summary

Dercum’s Disease is a chronic and often painful condition involving multiple subcutaneous lipomas and is frequently associated with obesity, metabolic issues and autoimmune disorders. It can significantly affect daily life, but symptom management, a healthy lifestyle and addressing related conditions can improve overall well-being.