Dermatologic Manifestations of Lipomas Treatment & Management

  • Author: Robert A Moraru, MD; Chief Editor: William D James, MD   more...
 
Updated: Jan 12, 2012
 

Medical Care

Surgical techniques typically are used; however, Dercum disease also has been treated medically using intravenous infusions of lidocaine,[11] steroids, and analgesic medications. Topical EMLA (eutectic mixture of lidocaine and prilocaine in a ratio of 1:1 by weight) also has been used for Dercum disease.[12] Intravenous use of lidocaine can be effective for Dercum disease; however, adverse effects typically outweigh benefits. Interferon alfa-2b apparently induced long-term pain relief in 2 patients with Dercum disease and chronic hepatitis.[13]

Mesotherapy[14, 15] is a treatment for body conturing that has been used for many years in Europe. Mesotherapy involves a series of injections containing many different ingredients, including vasodilators, nonsteroidal anti-inflammatory drugs, enzymes, and hormones. A common chemical used is lecithin (phosphatidylcholine isoproterenol), a lipolytic agent. However, one study has shown that when lecithin solubilized with deoxycholate was used to treat subcutaneous lipomas, the active ingredient was actually the deoxycholate rather than the phosphatidalcholine.[16] This study suggested that low-concentration deoxycholate may be a safe and effective treatment for small collections of fat. While more study is needed, mesotherapy may one day be the treatment of choice for certain lipomas.

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Surgical Care

Multiple surgical techniques can treat lipomas. Carefully evaluate infiltrating lipomas when considering excision, since they can develop in intramuscular or intermuscular locations. They also can infiltrate into tendon, bone, and nerve, thus requiring careful microdissection to preserve important structures.[17]

  • Simple surgical excision of lipomas
    • Mark the palpable borders on the skin before infiltrating with anesthesia, as shown in the image below.A 43-year-old man with a slow-growing asymptomaticA 43-year-old man with a slow-growing asymptomatic growth.
    • Incise skin down to the lipoma capsule, and dissect to free the mass from the surrounding tissue.
    • After obtaining hemostasis, close the dead space using buried absorbable sutures.
    • Remove excess skin, close the wound, and apply a pressure dressing for 24 hours to prevent hematoma or seroma formation.
  • Squeeze technique (for small superficial lipomas) for lipomas
    • Make a stab incision, which can be as small as one fourth of the lipoma's diameter.
    • Express the lipoma by putting pressure on the lateral aspects of the incision, as shown in the image below.Surgical excision of a 6-cm lipoma on the back of Surgical excision of a 6-cm lipoma on the back of a 54-year-old man using the squeeze technique.
    • Gentle dissection with a curette or blunt undermining scissors also may be required.
  • Liposuction for lipomas[18, 19, 20]
    • Liposuction has been shown to be an excellent method for removing lipomas, angiolipomas, the lipomas of Madelung disease, and adiposis dolorosa.
    • The advantages of liposuction include reduced operative time and smaller incisions.
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Contributor Information and Disclosures
Author

Robert A Moraru, MD  Staff Physician, Department of Dermatology, St Luke's/Roosevelt Hospital Center, Columbia Presbyterian Medical Center

Robert A Moraru, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Janet Fairley, MD  Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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  11. Juhlin L. Long-standing pain relief of adiposis dolorosa (Dercum's disease) after intravenous infusion of lidocaine. J Am Acad Dermatol. Aug 1986;15(2 Pt 2):383-5. [Medline].

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  13. Gonciarz Z, Mazur W, Hartleb J, et al. Interferon alfa-2b induced long-term relief of pain in two patients with adiposis dolorosa and chronic hepatitis C. J Hepatol. Dec 1997;27(6):1141. [Medline].

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A 43-year-old white man with a 3- to 4-year history of a slow-growing asymptomatic growth on his right shoulder.
A 43-year-old man with a slow-growing asymptomatic growth.
Surgical excision of a 6-cm lipoma on the back of a 54-year-old man using the squeeze technique.
 
 
 
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