Lumps under the skin fibromyalgia
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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One very common symptom expressed by fibromyalgia patients but not commented on in most textbooks is the presence of painful lumps under the skin.
These lumps are peculiar in that they can't be seen, but patients can feel them under the skin.
Some people attribute these lumps to bunched up superficial fascia. Superficial fascia is attached to the underside of the skin. Capillary channels and lymph vessels run through this layer, and so do many nerves. The subcutaneous fat is attached to it. In FMS and CMP, the superficial fascia becomes lumpy.
Another explanation for these lumps is a condition called Dercum’s disease.
Diagnosis requires a history of at least three months of chronic pain in fatty tissue, either constant or recurring. Some authorities add (1) generalized obesity (2) weakness and excessive fatigue and (3) mental disturbances, including depression, confusion, emotional instability, epilepsy, and dementia.
Many people with Dercum’s report depression, confusion (often called “brainfog”) and memory issues. Much of the literature reports that Dercum’s occurs most often in obese postmenopausal women. However, it does occur in teenagers and young adults, and about one in twenty patients are male. While weight gain is common, there are many people with Dercum's who have never been overweight. Weight loss has no influence on the size of the lumps.
Other diseases which may be confused with Dercum’s include familial multiple lipomatosis (benign fatty tumors), which is an inherited condition of non-painful lipomas, lipodystrophy, and Madelung’s disease. Some lipomas may be painful because they put pressure on nerves, but most are not.
In Dercum’s disease most or all lipomas and other fat deposits are tender or painful. In particular, mild trauma to a Dercum’s lump or lipoma usually hurts. Sometimes lipomas in Dercum’s are angiolipomas - lipomas which contain blood vessels.
Painful fat can occur anywhere on the body, including the head and neck.
Dercum’s has been classified into three types, based on the location and character of the painful fatty tissue. One can have a mixture of two types. These are:
Type I, or the juxta-articular type, with painful areas of fat on the inside of the knees and/or on the hips, and in the arms.
Type II, or the diffuse, generalized type, where widespread pain from fatty tissue is found also in the dorsal upper-arm fat, in the axillary (armpit)and gluteal (buttock) fat, in the stomach wall, both in front and along the sides, and on the soles of the feet. This is the most common type.
Type III, or the nodular type, presents with pain in and around multiple lipomas.
Many patients with type III Dercum's report small rubbery nodules. These often grow together into clumps. These seem to occur most often in the arms, abdomen, and ribs.
Pain is common when a lipoma is bumped, pressed, or pinched. Sometimes even the lightest pressure can be painful.
The intensity of the pain varies from mild to excruciating. Pain often increases during menstruation, and decreases with warmth and high barometric pressure. Stress, both physical and psychological, appears to make the symptoms of Dercum’s worse.
Other problems which commonly occur with Dercum’s disease include the following.
Swelling that appears and often recede for no apparent reason. The swellings are non-pitting. In some cases, after the swelling subsides, adipose tissue increases under the skin.
Sleep disturbances are common.
Numbness, tingling and burning in the limbs, particularly the hands and feet, can occur.
Thyroid problems may occur. This is most commonly an underactive thyroid, but overactive thyroid has also been noted.
Other problems are also reported, such as fibromyalgia, carpal tunnel syndrome, tendonitis, irritable bowel, and pain in the tailbone and vulva.
It is rare for cancer to develop in an existing lipoma. There doesn’t appear to be any higher chance of developing cancer because one has Dercum’s disease.
No one knows what causes Dercum’s disease, but it appears to be hereditary in some instances.
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