We usually hear about liposuction when it comes to cosmetic procedures – but did you know it can also be used to treat rare conditions like Dercum’s disease? 

Introduction 

Dercum’s disease, also known as adiposis dolorosa, is a rare condition that mainly affects women, particularly after menopause.¹ It is described as having multiple painful fatty masses called lipomas throughout the body. 

Living with Dercum’s disease can be extremely challenging. Along with the painful lumps, women can experience: 

• Weight gain 
• Depression 
• Constant, widespread pain 
• Tiredness and low energy 

Doctors still don’t know exactly what causes the condition. Hormones, genetics, stress, and problems with the lymphatic system all play a crucial role in women’s bodies. Often, Dercum’s disease can be misdiagnosed as obesity.² It is a very rare condition, affecting roughly 1 in 50,000 to 1 in 500,000 people, and it is more common in women, usually appearing between the ages of 30 and 50.²

There are four types of Dercum’s disease: 

• Diffuse form 

People experience widespread, constant pain throughout their fat tissue, but there are no clearly defined lumps. The discomfort can feel like a deep ache or tenderness spread across large areas of the body.

• Generalised nodular form 

In addition to general pain throughout the body, people may develop multiple distinct, painful lumps (lipomas) scattered across different areas. Imagine small, soft balls of tissue under the skin. These lumps can be tender and may flare up, making daily activities uncomfortable.

• Localised nodular form

With this type, pain is focused in specific areas where several lipomas have formed. The lumps are easier to see and feel, and the discomfort is usually concentrated in one area, such as the leg, rather than throughout the whole body. 

• Juxta-articular form 

This type involves the development of painful fat masses near joints, such as the knees, elbows, or hips. Walking or bending can occasionally become uncomfortable due to these localised lumps that impair joint functions and movements. 

Liposuction as a treatment 

Because the standard pain medicines rarely help, doctors have looked at surgical approaches. Liposuction, a procedure best known for cosmetic fat removal, was tried as a possible treatment. 

The reason behind it: 

• Removing the painful fatty tissue might reduce symptoms
• Destroying small nerve networks within the fat could reduce pain signals 

Unlike cosmetic liposuction, this version of it is aimed at improving symptoms, not reshaping the body proportions. It is considered for people with large, painful fat deposits in specific areas like the thighs, arms, or abdomen. It is not recommended for those who constantly develop new lipomas.¹

What the research says 

Short-term results: some relief

The most important studies on this topic were carried out in Sweden by Drs. Emma Hansson and Håkan Brorson. Their research showed that after liposuction, patients often reported less pain and better quality of life in the first months following surgery.³  

Long-term results: pain comes back

Unfortunately, the good news doesn’t last. Over several years, the pain almost always returned to its original levels. By the five-year mark, most patients experienced the same pain they had before the procedure.³

Quality of life findings

Follow-up studies found only a slight improvement in daily life after surgery, and even then, the benefits weren’t strong enough to justify recommending liposuction as a standard treatment.⁴

Safety and risks

Like any surgery, liposuction carries risks. Common issues include:

• Infection
• Scarring
• Fluid build-up under the skin (seroma)

More serious but rare complications include fat particles entering the bloodstream (fat embolism).

People with Dercum's disease face extra risks when undergoing liposuction. The procedure is generally considered high-risk for these patients, often requiring about a week of care in a plastic surgery department. 

Research has shown that Dercum's patients tend to experience:

• Higher levels of post-operative pain than in typical liposuction patients.
• More frequent complications, including slower wound healing and increased sensitivity at the surgical site.¹

Risks to the lymphatic system 

One of the most concerning risks for Dercum's patients is that their lymphatic system may become injured. Many people with Dercum's already have problems with their lymphatic system, which helps drain fluid and fight infection. 

This can get worse with liposuction, which can cause:

• Swelling in the operated limbs.
• Long-term drainage problems.
• Increased risk of further pain and complications.

Surgical complications specific to dercum’s disease

In some cases, surgery itself may trigger the development of new lipomas in treated areas due to inflammation during the healing process. 

Wollina et al. reported outcomes from a series of tumescent liposuction procedures in four patients with Dercum’s disease. All patients experienced pain reduction; however, methaemoglobinaemia, a rare blood-related complication, occurred in each case.⁵

These findings suggest that although liposuction can temporarily reduce pain, the procedure carries significant risks for this patient group and requires careful consideration and close post-operative monitoring. 

Alternatives being explored

Because liposuction’s benefits are short-lived, researchers are studying other options:

• Manual therapies – Such as lymphatic drainage massage can ease swelling and pain, especially when combined with medication
• Medications – Drugs like pregabalin (commonly used for nerve pain) have shown promise. Other drugs, including methotrexate and infliximab, are being studied
• Emerging techniques – New approaches like electrical stimulation or fat-dissolving injections (deoxycholic acid) are under investigation

Who might still be considered for surgery?

In some carefully selected cases, liposuction may still be an option. Patients need:

• Thorough pre-surgery screening (blood tests, clotting checks)
• An experienced surgeon familiar with removing fibrotic tissue
• Supportive therapies before and after surgery to control inflammation

Even then, expectations must be realistic: liposuction is unlikely to offer lasting relief.

Where treatment for dercum’s disease is headed? 

Currently, there’s no universally accepted treatment plan for Dercum’s disease. Instead, doctors tend to emphasise managing symptoms like pain, fatigue, and emotional challenges on a case-by-case basis.⁶ Future strategies will likely continue this trend, such as creating personalised treatment plans that blend medical, physical, and psychological care to improve patients’ day-to-day lives. There is an urgent need for high-quality studies. Most of the evidence so far comes from small case reports or isolated observations.⁶

To truly move forward, the Dercum’s research community needs:

• Larger patient studies or registries
• Randomised trials comparing treatment approaches
• Long-term outcome tracking

These types of studies could finally provide solid answers about what treatments work best and why.

Newer treatments like electrical stimulation or fat-dissolving injections are showing early promise in shaving off symptoms or shrinking lipomas. Developing these further and testing them scientifically will be key to offering patients safer, more innovative options.

FAQs

How is dercum’s disease different from obesity? 

The main distinction between Dercum’s disease and obesity is pain. People with Dercum’s disease suffer from a significant amount of pain due to lipoma formations. Unlike obesity, the fat growth is abnormal and causes significant pain, fatigue, and other symptoms. 

Is there a standard treatment for dercum’s disease? 

At the moment, there is no universally accepted treatment for Dercum’s disease. Management usually focuses on relieving pain, reducing fatigue, and addressing emotional symptoms with a personalised care plan. 

Can diet help manage dercum’s disease?

There is no specific diet that can cure Dercum's disease, but eating well may help manage the symptoms. Some patients say they feel better when they eat an anti-inflammatory diet that is high in fruits, vegetables, lean proteins, and omega-3 fatty acids. You might also feel better and have less inflammation if you stay away from highly processed foods, refined sugars, and too much alcohol. But diet alone can't stop lipomas from forming.

Summary 

Dercum's disease (adiposis dolorosa) is an extremely rare condition that causes painful fatty lumps (lipomas) to form. It usually affects women between the ages of 30 and 50. Together with the lumps, patients often have a lot of pain, tiredness, weight gain, and depression, which makes it hard to get through the day. The root cause is still not known, but hormones, genes, and the lymphatic system are thought to be involved.

Because regular painkillers don't always work, researchers have looked into liposuction as a possible treatment. The idea is that taking out painful fat cells and breaking up the nerve networks inside them could help with symptoms. Early studies, especially those from Sweden, showed that patients felt less pain and had a better quality of life in the short term. However, these improvements were temporary for around five years, and most patients’ pain had returned to pre-surgery levels. Liposuction also carries significant risks for this patient group. Patients with Dercum's disease are reported to have even more problems, such as slower wound healing, more pain after surgery, and possible damage to the lymphatic system. 

Future management will likely focus on personalised, symptom-based approaches. Alternatives under study include lymphatic drainage therapies, nerve pain medications, and newer techniques like electrical stimulation or fat-dissolving injections. Larger clinical studies are needed to identify safer and more effective long-term treatments.