Benign symmetric lipomatosis explained

Benign symmetric lipomatosis
Synonyms:Benign symmetric lipomatosis of Launois–Bensaude; Madelung's disease; multiple symmetric lipomatosis; cephalothoracic lipodystrophy; symmetrical adenolipomatosis; fat neck (Fetthals)
Field:Dermatology, endocrinology
Onset:Adult-onset

Benign symmetric lipomatosis, also known as Madelung's disease, is an adult-onset skin condition characterized by extensive symmetric fat deposits in the head, neck, and shoulder girdle area.[1] The symmetrical fat deposits are made of unencapsulated lipomas, which distinguishes it from typical lipomatosis which has encapsulated lipomas that are not usually symmetrical. Benjamin Brodie described the condition in 1846. The German surgeon Otto Wilhelm Madelung was the first to give a detailed description of the disorder in 1888, followed by Launois and Bensaude in 1898.

This condition is rare, with an estimated incidence of 1 in 25,000 in Italy.[2] Older research found that it affects males up to 15 - 30 times more frequently than females;[3] however, more recent studies have found a higher prevalence among women than men (1:2.5) and so further epidemiological studies are needed. It predominantly affects those of the Mediterranean and European populations, although rare cases have been documented outside of those populations[4] (such as Ethiopian,[5] Chinese,[6] Mexican-American,[7] Indian,[8] African-American,[9] and African-Indian[10]).

Large fat deposits around the neck, and more rarely in the tongue, may negatively affect breathing, swallowing, and speaking.[11] [12] Orbital involvement is very rare, with proptosis (bulging of the eye) and persistent bilateral lumps on the eyelids.[13] [14]

Comorbidities frequently involve the endocrine systems, with hypercholesterinemia and hypothyroidism being the most common. Other comorbidities include diabetes mellitus, hypertension, and gout. In individuals with alcohol use disorder, there is also alcohol-related cirrhosis of the liver. There have also been reports of peripheral neuropathy, ragged red fibres in muscle cells (suggesting mitochondrial myopathy), sudden cardiac death, and neurological involvement, although it is unknown whether these are due to prolonged alcohol use disorder as such symptoms of mitochondrial dysfunction also appear in alcoholics without Madelung's disease.[15] [16] However, rarely, instances of mitochondrial dysfunction (high lactate/low pyruvate, polyneuropathy, decreased cytochrome c oxidase and abnormal mitochondria) have been documented in non-alcoholics with Madelung's disease.

Cosmetic disfigurement due to the fat deposition in the cervicothoracic region results in a "pseudoathletic appearance," resembling the Italian statue Warrior of Capestrano and carvings of Queen of Punt (Egypt).[17] The fat deposited around the front of the neck is known as Madelung's collar or horse collar. Fat deposited on the back of the neck between the shoulder blades is known as a dorsocervical fat pad or buffalo hump.[18] Fat deposited in the parotid region is known as hamster cheeks.

Cause

The cause of the disease remains unknown, but its incidence strongly correlates with alcohol use disorder (over 90% of cases); in such cases, abstinence from alcohol prevents disease progression. Defects in the adrenergic-stimulated lipolysis and accumulation of embryological brown fat have also been reported.

Types

Earlier, the disease was classified by G. Enzi and others into two types:

In 1991, Donhauser classified the disease into four types, which subsequently became a commonly accepted classification:

In 2018, a new classification was proposed, as most of the patients in the largest German study of that time did not reliably fit into the Donhauser classification system. Schiltz and others at the University Hospital Regensburg proposed the disease to be classified into five types:

Treatment

Traditionally the treatment is mainly surgical, consisting of the removal of the lipomas (lipectomy), although recent study has proposed liposuction and phosphatidylcholine injection as possible alternatives.[19]

Society

The appearance of people with the disease is depicted in:

See also

Notes and References

  1. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
  2. Schiltz . Daniel . Anker . Alexandra . Ortner . Christine . Tschernitz . Sebastian . Koller . Michael . Klein . Silvan . Felthaus . Oliver . Schreml . Julia . Schreml . Stephan . Prantl . Lukas . April 2018 . Multiple Symmetric Lipomatosis: New Classification System Based on the Largest German Patient Cohort . Plastic and Reconstructive Surgery. Global Open . 6 . 4 . e1722 . 10.1097/GOX.0000000000001722 . 2169-7574 . 5977945 . 29876171.
  3. González-García R, Rodríguez-Campo FJ, Sastre-Pérez J, Muñoz-Guerra MF . Benign symmetric lipomatosis (Madelung's disease): case reports and current management . Aesthetic Plast Surg . 28 . 2 . 108–12; discussion 113 . 2004 . 15164232 . 10.1007/s00266-004-3123-5. 45300059 .
  4. Web site: Madelung's Disease . NORD (National Organization of Rare Disorders).
  5. Zewde . Yared Zenebe . 2021-07-03 . Madelung's disease in a non-alcoholic Ethiopian male patient mistaken for obesity: a case report . BMC Endocrine Disorders . 21 . 1 . 142 . 10.1186/s12902-021-00803-9 . 1472-6823 . 8254943 . 34217263 . free .
  6. Wanke . Jin . Yongjing . Fan . February 2022 . A case report of Madelung's disease in China . Radiology Case Reports . 17 . 2 . 320–325 . 10.1016/j.radcr.2021.10.035 . 1930-0433 . 8633830 . 34876958.
  7. Web site: Madelung's Disease with polyneuropathy in a non-alcoholic Mexican-American male . 2023-10-22 . www.oatext.com . en.
  8. Suresh Chandran . C. J. . Godge . Y. R. . Oak . P. J. . Ravat . S. H. . April 2009 . Madelung's disease with myopathy . Annals of Indian Academy of Neurology . 12 . 2 . 131–132 . 10.4103/0972-2327.53086 . 1998-3549 . 2812741 . 20142863 . free .
  9. Sarhill . N. . Kumar . Ajay . Cook . L. . Tahir . A. . Barakat . K. . 2006 . Madelung's Disease in an African-American Patient . 78759779 .
  10. Medappil Noushif . Vasu TA . July 2010 . Madelung's disease: A spot diagnosis . Indian J Plast Surg . 43 . 2 . 227–8 . 10.4103/0970-0358.73472 . 3010793 . 21217991 . free.
  11. Louza . Guilherme Felix . Zanetti . Gláucia . Marchiori . Edson . August 2022 . Madelung's Disease: A Rare Cause of Dyspnea . Archivos de Bronconeumologia . 58 . 8 . 612 . 10.1016/j.arbres.2021.09.015 . 1579-2129 . 35312558. 241472327 .
  12. Lopez-Ceres . Ana . Aguilar-Lizarralde . Yolanda . Villalobos Sánchez . Aurora . Prieto Sánchez . Elisa . Valiente Alvarez . Antonio . December 2006 . Benign symmetric lipomatosis of the tongue in Madelung's disease . Journal of Cranio-Maxillo-Facial Surgery. 34 . 8 . 489–493 . 10.1016/j.jcms.2006.06.003 . 1010-5182 . 17157517.
  13. Şükün . Abdullah . Demirci . Mehmet Fatih . Akbay . Ertan . June 2023 . Type 1C Multiple Symmetrical Lipomatosis: A Cause of Misdiagnosis in Females . Cureus . 15 . 6 . e40970 . 10.7759/cureus.40970 . 2168-8184 . 10370365 . 37503462 . free.
  14. Lumyongsatien . Mingkwan . Selva . Dinesh . April 2022 . Bilateral symmetric lipomatosis of the orbit in Madelung's disease . Orbit (Amsterdam, Netherlands) . 41 . 2 . 268–270 . 10.1080/01676830.2020.1852261 . 1744-5108 . 33243058. 227182356 .
  15. Klopstock . T. . Naumann . M. . Schalke . B. . Bischof . F. . Seibel . P. . Kottlors . M. . Eckert . P. . Reiners . K. . Toyka . K. V. . Reichmann . H. . May 1994 . Multiple symmetric lipomatosis: abnormalities in complex IV and multiple deletions in mitochondrial DNA . Neurology . 44 . 5 . 862–866 . 10.1212/wnl.44.5.862 . 0028-3878 . 8190288. 2474345 .
  16. Naumann . M. . Schalke . B. . Klopstock . T. . Reichmann . H. . Lange . K. W. . Wiesbeck . G. . Toyka . K. V. . Reiners . K. . July 1995 . Neurological multisystem manifestation in multiple symmetric lipomatosis: a clinical and electrophysiological study . Muscle & Nerve . 18 . 7 . 693–698 . 10.1002/mus.880180704 . 0148-639X . 7783758. 27498996 .
  17. Miraglia . E. . Moliterni . E. . Iacovino . C. . Chello . C. . Laghi . A. . Giustini . S. . 2021-05-05 . Madelung's disease. Two case reports with pseudoathletic appearance . La Clinica Terapeutica . 172 . 3 . 190–192 . 10.7417/CT.2021.2311 . 1972-6007 . 33956034.
  18. Liu . S -Z . Zhou . X . Wang . Y -P . Liu . Y . Song . A . 2019-06-26 . The Madelung's disease and the buffalo hump sign . QJM: An International Journal of Medicine . 113 . 3 . 219 . 10.1093/qjmed/hcz160 . 1460-2725 . 31250017 . free.
  19. Hasegawa T, Matsukura T, Ikeda S . Mesotherapy for Benign Symmetric Lipomatosis . Aesthetic Plast Surg . 34. 2. 153–6. June 2009 . 19488808 . 10.1007/s00266-009-9374-4. 1678529 .
  20. Book: Leon, Donna. Beastly Things (Commissario Brunetti, #21). 2012. Grove/Atlantic. 978-0802120236. 5 of Chapter 3. registration.

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