‘Madelung’s Disease‘ refers to a rare, inherited disorder of the liposuction-scar tissue. Like most liposuction-related disorders, the disease is caused by excessive bleeding and inflammation following surgery. Common symptoms include persistent postoperative pain (especially when food is swallowed), diffuse alopecia (loss of hair on the head and chest), and symmetric liposuction. To understand the precise pathogenesis of this disease and to design an effective surgical treatment, it is crucial to appreciate the pathophysiology of the disease and to exclude comorbidities.
History of Madelung’s Disease
As a matter of historical fact, the first patient to suffer from ‘Madelung’s Disease‘ was Dr. Eberhard Luecker, in 1930. Because of the extreme complexity of the diagnostic process, the diagnosis of this condition has been more arduous than for other similar liposuction disorders. Unfortunately, despite modern advancements in diagnostic imaging tests, the accuracy rate of the diagnosis is as high as only 25%. Furthermore, because of the inherent variability of the patient’s presentation with respect to disease diagnosis, and to the extent of damage to the lymphatic system and local tissue fillers, a definitive diagnosis may be difficult to achieve even after performing all the necessary tests.
The Ayurvedic treatment of Madelung’s disease is aimed at correcting the underlying pathology of this condition, treating the pain and other manifestations of the disease, and preventing a recurrence of the disease. This disorder is classified into two subtypes: grade I and grade II. In grade I, the disease causes diffuse fat accumulation around the upper body, with little to no skin involvement. Grades II and III are characterized by fat deposition with or without local skin involvement, often within the arms or hands. The severity of the disease typically increases with age but may present in younger people.
Differential Diagnosis of Madelung’s Disease
The differential diagnosis for this condition involves evaluating a patient’s response to treatment including measures of lymphocytic activity, hemoglobin levels, and urination. If the disease is suspected based on any of these evaluations, additional testing is required. These include blood count, complete blood count, symptom score, fasting plasma glucose level, and liver enzymes (AST, ALT). In addition, metabolic function tests are also important in determining whether the patient has Madelung’s syndrome. The most common test used to evaluate for this condition is the fasting insulin test, which is based on the measurement of the fasting blood glucose level.
Another differential diagnosis of Madelung’s disease is chronic alcohol abuse, including chronic alcoholism and cirrhosis of the liver. Because the disease is more likely to occur in someone who suffers from alcoholic hepatitis, it is also important to perform tests to rule out liver disease, especially if the patient has had cirrhosis of the liver in the past. A recent study by Rush University Medical School in Chicago compared patients with Madelung’s disease and chronic alcohol abuse and found that those patients who had chronic alcohol abuse had three times the risk of developing Madelung’s disease.
Lastly, other conditions that have been associated with the disease include pancreatitis, steatosis, hypocalcemia, hypercholesterolemia, lipolysis, insulin resistance, and malignancy. Because the exact mechanism by which Madelung occurs is not clearly understood, patients with the disease may display a wide range of symptoms. Symptoms may include proximal muscle disease, wasting, atherosclerosis, fibrosis, and fibrosis within the pancreas and liver. While these diseases are the result of a variety of causes, they all appear to occur due to the increased deposits of fat breakdown products in the pancreas and liver.