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Painful nodes or lumps under the skin

Painful nodes or lumps under the skin are a problem that affects many people, and this condition can strike for several different reasons. These skin lumps are often not a disease in itself, and they are rather a symptom of an underlying condition. This means that, to treat the nodules, you will first need an accurate diagnosis. This overview of common causes of painful nodules under the skin is there to help.


Fibromyalgia is a disorder with many different symptoms, including muscle and connective tissue pain. One symptom of this disorder, which is not widely commented in textbooks, is the presence of painful lumps under the skin, also called "tender points".

Some attribute these lumps to superficial fascia that get stuck. Superficial fascia is found underneath the skin. Lymph vessels, capillary channels and nerves run through it and subcutaneous fat, meaning fat just beneath the skin, is attached to it. In fibromyalgia, it can get stuck and the skin does not flow normally and fluidly over the muscles.

Tender points in fibromyalgia can occur on the upper chest, at the base of the neck, over the insides of the knees and elbows, on the shoulder blades and the upper back, over the hips and around the buttocks, and even at the back of the head. In general, they tend to be bilateral, meaning if you have a tender point on one side of the body, the same body part on the other side will also be affected.

Dercum’s disease

Dercum’s disease or adiposis dolorosa is another possible explanation for painful nodule-like lumps beneath the skin, called lipomas. Lipomas are composed of fatty tissue. The symptoms of this disease include pain in fatty tissue, often with weight gain, fatigue, loss of stamina, and mental disturbances including depression, anxiety, confusion, and dementia.

Dercum's disease mostly affects overweight women, especially of postmenopausal age.

Some diseases can be confused with Dercum’s. Those are multiple lipomatosis, lipodystrophy and Madelung’s disease. However, in these diseases the lipomas may cause pain if they press on the nerves, but otherwise they are painless, while lipomas caused by Dercum’s disease are tender or painful. The pain increases when they are bumped, and if they are squeezed or pinched they hurt a lot.

In this disease, the lumps underneath the skin may form in all parts of the body, and in some cases they can virtually be present anywhere from head to toe.

Usually, the painful skin nodules affect the subcutaneous fat layers although they are known to affect other tissues as well.

The pain is described as stabbing, aching or burning. It can range from mild discomfort to excruciating pain. In women of reproductive age, the pain gets worse during menstruation and lessens with warm weather and high pressure. If the lumps get infected, the pain gets worse. The pain increases with high stress and anxiety levels, as well.

Another problem associated with this disease is swelling, which can be confused with water retention. However, unlike water retention, the swelling caused by Dercum's disease does not pit when pressed with a thumb. When the swelling recedes, it leaves sagging skin.

Other symptoms of Dercum’s disease include sleep disturbances, tingling sensations, numbness and burning sensation in the limbs.

The exact cause of Dercum’s disease is yet unknown but it is believed to be hereditary.

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