The regulation of subcutaneous blood flow in patient with Dercum's disease

Dercum's disease or adiposis dolorosa is a poorly understood disorder with painful fatty deposits in the skin localized to the lower extremities. The etiology is unknown. In such a patient the mechanisms of local regulation of blood flow in subcutaneous tissue was investigated by the local 133Xenon washout technique. The patient was reinvestigated one week after treatment with intravenous lidocaine. The local vasoconstrictor response to increase in venous transmural pressure was not present in this patient, but reappeared after lidocaine treatment. Autoregulation of blood flow in subcutaneous tissue was present before as well as after lidocaine treatment. It seems likely that a pain elicited increase in sympathetic activity in the vasoconstrictor fibres abolished the normal vasoconstrictor response to increase in venous transmural pressure. The mechanism of pain relief after intravenous lidocaine infusion is uncertain, but central as well as peripheral mechanisms may be considered.