ArticleLiterature Review

Lipoedema: From clinical presentation to therapy. A review of the literature

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Abstract

Lipoedema is an infrequently recognized disorder in women. Lipoedema is characterized by bilateral enlargement of the legs due to abnormal depositions of subcutaneous fat associated with often mild oedema. There is substantial variability in disease severity. The diagnosis should be made as early as possible to prevent complications of the disorder, which is associated with increasing functional and cosmetic morbidity. This review describes clinical manifestations, pathogenesis, technical investigations, management and therapies of lipoedema, with the aim of optimizing management and care of patients with lipoedema.

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... Lipedema often affects several female members of the same family, suggesting a genetic disorder [5] . A positive family history is common and ranges between 16% and 64% [6] , but is likely higher due to under-diagnosis. Autosomal dominant inheritance with incomplete penetrance and sex limitation is the most likely mode of inheritance [5,7] . ...
... The diagnosis of lipedema is usually based on medical history and clinical features [6] . One criterion is the onset of the disease in parallel with hormonal changes and occurrence mainly in women [1,12] . ...
... One criterion is the onset of the disease in parallel with hormonal changes and occurrence mainly in women [1,12] . Lipedema typically presents with a disproportionate enlargement of the limbs in relation to the upper part of the body [6,13] [ Figure 1]. Increase of adipose tissue of the limbs is symmetrical, without involvement of feet or hands. ...
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Lipedema is a frequently unrecognized and misdiagnosed disorder of the fatty tissue of extremities and hips, which affects almost purely women. The beginning of the disease usually occurs with hormonal changes, such as puberty, pregnancy, or menopause. Women suffer from pain, easy bruising, and disfigurement, which may lead to early immobility and social stress. Accurate diagnosis and treatment are essential. The differentiation between obesity and lipedema is difficult, as these two different entities often occur together. Other differential diagnoses are lymphedema, benign lipohypertrophy, and Dercum’s disease. A therapy targeting the underlying cause of lipedema is not available because the exact etiology of the disorder is not clarified yet. Decongestive physical therapy is the basic conservative treatment, which is usually necessary lifelong. However, liposuction has led to a paradigm shift in the treatment of lipedema. The purposes of this article are to describe the symptoms and treatment options of the still fairly unknown disease Lipedema and to show the distinctions to its differential diagnoses.
... 4 In a typical presentation of lipedema, the enlargement of the lower extremities is disproportionately greater than that of the trunk and upper extremities. 8 Initially, the first sign indicating the development of lipedema may be filling of the retro-malleolar sulcus on both lower extremities; in most cases, the feet are unaffected and the fat begins to accumulate above both malleoli, which creates for a visible distinction between the normal and abnormal tissue near the ankle, known as the "cuff sign" (Figure 1). 8 In addition, fat pads are usually found anterior to the lateral malleolus with additional tissue present between the Achilles tendon and medial malleolus. ...
... 8 Initially, the first sign indicating the development of lipedema may be filling of the retro-malleolar sulcus on both lower extremities; in most cases, the feet are unaffected and the fat begins to accumulate above both malleoli, which creates for a visible distinction between the normal and abnormal tissue near the ankle, known as the "cuff sign" (Figure 1). 8 In addition, fat pads are usually found anterior to the lateral malleolus with additional tissue present between the Achilles tendon and medial malleolus. 4 The skin is usually normal in appearance, and there is no apparent dermal thickening or induration, which is a common feature found in lymphedema (Figure 3). ...
... In some cases, there may also be extensive fatty deposition in the upper extremities that spares the wrist, in the same manner as the feet are spared in the lower extremities. 8 Other clinical features of lipedema may include a mild pitting edema that can improve with elevation and a sensation of heaviness or discomfort in the legs that is worsened with pressure; this feature has previously been described in the literature as "painful fat syndrome." 4 The presence of tenderness has been reported in 70% of these patients. ...
Article
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Lipedema is a rare painful disorder of the adipose tissue. It essentially affects females and is often misdiagnosed as lymphedema or obesity. It is globally misdiagnosed or underdiagnosed and the literature is lacking an appropriate guidance to assist clinicians towards this diagnosis. However, the need to recognize this disorder as a unique entity has important implications to establish the proper treatment and therefore tremendous effect on patients. Early diagnosis and treatment can turn these patient’s lives upside down. The aim of this review is not mainly to discuss lipedema as a unique entity in respect to epidemiology and pathogenesis, rather to put a focus on the clinical guidance, differential diagnosis, and management strategies. Lipedema is distinct from obesity and distinct from lymphedema although it might progress to involve the venous and lymphatic system (venolipedema or lympholipedema or both). Late diagnosis can leave the patient debilitated. Management of lipedema include weight loss, control of edema, complex decongestive physiotherapy liposuction, and laser-assisted lipolysis. However; there are growing reports on tumescent liposuction as the preferred surgical option with long lasting result. The role of newer randomized controlled studies to further explore the management of this clinical entity remains promising.
... Positive familial history has been also reviewed. Although positive family inheritance is not proven for lipedema, the rate of having a positive family history in lipedema patients ranged from 16 to 64% [17]. Child et al. [1] investigated 330 family members; in 10 out of 67 of them who were affected by lipedema, family history was positive. ...
... Columnar phenotype, which can be described as an enlargement of the lower extremity portions through conic sections, seems to be more frequent in prevalence. Lobar type, which is observed rather less common, can be described as large bulges or lobes placed on the hip region or lower extremities [17][18][19]. A few patients can show a mixed type of both phenotypes as stated in researches [7]. ...
... Beginning with a thorough documentation and taking a detailed medical history in the assessment of lipedema are suggested. Since the pathophysiological background of the condition is not well known, possible mechanisms should be considered and documented [17]. ...
Article
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Lipedema, which has been known as an adipose tissue disorder characterized by abnormal fat deposition, mostly affects women. This condition can easily be ruled out regarding its diagnosis because it is commonly misdiagnosed as obesity. True diagnosing and optimal management of lipedema show a great importance. As patients suffer from lipedema, not only experiencing physical symptoms such as tenderness or a feeling of heaviness but also psychological symptoms such as anxiety, they cause negative influences on quality of life of a person with lipedema. This paper tries to review all aspects of lipedema from diagnosis to management and assessment options.
... Die Erkrankung tritt fast ausschließlich bei Frauen auf und manifestiert sich häufig während Phasen hormoneller Umstellungen [2]. Eine familiäre Häufung wird in zumindest 16 % der Fälle beschrieben [3]. ...
... Die Diagnose Lipödem beruht im Wesentlichen auf anamnestischen und klinischen Kriterien [3]. Ein wichtiges anamnestisches Kriterium ist ein Erkrankungsbeginn in der Pubertät, Schwangerschaft oder Menopause [1,8]. ...
... Charakteristischerweise klagen die Patientinnen über Schmerzen, eine ausgeprägte Neigung zu Hämatomen, Berührungs-und Druckempfindlichkeit sowie Verschlimmerung der Beschwerden mit zunehmender Flüssigkeitseinlagerung im Verlauf des Tages [2,9]. Ein wichtiges Diagnosemerkmal ist das klassische Erscheinungsbild mit einer Disproportion zwischen Unter-und Oberkörper mit deutlich schlankerem Oberkörper und voluminöserer unterer Körperhälfte [3,12] (▶ Abb. 1). Der isolierte Befall des Oberkörpers ist jedoch auch möglich. ...
Article
Zusammenfassung Das Lipödem ist eine schmerzhafte, chronisch-fortschreitende Erkrankung, die durch eine symmetrische Unterhautfettgewebsvermehrung mit Flüssigkeitseinlagerung an den Beinen und/oder Armen gekennzeichnet ist. Durch Unkenntnis über das Krankheitsbild wird die Erkrankung häufig nicht erkannt oder fehlgedeutet. Eine korrekte Diagnostik und Behandlung ist jedoch wichtig, da die Prognose der Erkrankung beeinflusst werden kann. Eine kausale Therapie für das Lipödem ist nicht bekannt, da die genaue Ätiologie noch nicht vollständig geklärt ist. Aufgrund einer beschriebenen familiären Häufung der Erkrankung wird eine erbliche Komponente vermutet. Da das Lipödem fast ausschließlich bei Frauen auftritt und der Erkrankungsbeginn häufig mit Einsetzen von hormonellen Veränderungen in Zusammenhang steht (Pubertät, Schwangerschaft, Menopause), wird außerdem dem Östrogen eine entscheidende Bedeutung für die Entstehung zugemessen. In der vorliegenden Arbeit präsentieren wir einen Überblick über die Symptome und klinischen Merkmale des Lipödems, seine Differenzialdiagnosen, die Behandlungsmöglichkeiten und zuletzt die aktuellen Hypothesen zur Pathogenese des Lipödems.
... In 60% of patients suffering from lipedema, genetic background with familial predisposition has been described (15). Studies have suggested that positive family history in affected patients ranges between 16% and 64% (16). Furthermore, a clinical report on 330 family members found a possible autosomal dominant inheritance with incomplete disease penetrance, though genes involved have not been identified, and the unusually high prevalence of BMI consistent with obesity in the study raises questions about its applicability in the absence of obesity (5). ...
... Taking into account these findings, research is still needed to clarify whether a persistent and progressive damage of the microlymphatic vessels because of adipose tissue expansion (16), rather than a primary lymphatic defect, may be responsible for the lipo-lymphedema state. ...
... Overall, disease progression is heterogeneous and highly variable from one individual to the other. Indeed, some women develop minor lipedema, stabilizing over time, while others exhibit gradual disease progression with sudden stress-induced exacerbation (i.e., pregnancy or surgery) (16). ...
Article
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Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.
... However, the increased intercellular pressure due to expanding fat tissue (because of disproportionate enlargement of the adipocytes) may cause slight mechanical obstruction of the small lymphatic vessels in the septa, which result in mild lymphostasis and oedema of the subcutaneous tissue. 4,5 However, some publications suggest that a microangiopathy of the lymph capillaries located in the connective tissue septa between fat lobes 6 causes increased permeability due to a fragile vessel wall. Similarly, the easy bruising might be explained by a capillary fragility. ...
... Tumescent liposuction is at least as effective as the conventional ('dry') liposuction and the so-called wet liposuction in removing adipose aspirates, but has the advantage that it is significantly less likely to damage the lymphatic vessels. 4,6,23,24 However, there is not much scientific research done on this topic. ...
... The diagnosis of lipoedema of the legs was established by clinical history and physical examination. 4 We used standardized lymphoscintigraphy to quantify the lymph flow in all lipoedema patients. The lymphatic function in lipoedema patients was compared with those obtained from normal volunteers. 1 Normal values of clearance (disappearance from the depot) and inguinal uptake after 2 h post injection have previously been established through evaluation of a series of normal healthy volunteers without leg swelling or other clinical evidence of venous or lymphatic disease. ...
Article
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Background Lymphatic insufficiency might play a significant role in the pathophysiology of lipoedema. Liposuction is up to now the best treatment. As liposuction is invasive, the technique could destruct parts of the lymphatic system and by this aggravate the lymphatic component and/or induce lymphoedema. We investigated the function of the lymphatic system in lipoedema patients before and after tumescent liposuction and thus whether tumescent liposuction can be regarded as a safe treatment. Methods Lymphoscintigraphy was performed to quantify the lymph outflow of 117 lipoedema patients. Mean clearance percentages of radioactive protein loaded after 1 min with respect to the total injected dose and corrected for decay of the radiopharmaceutical in the subcutaneous lymphatics were used as functional quantitative parameters as well as the clearance percentages and inguinal uptake 2 h post injection. The results of lymphatic function in lipoedema patients were compared with values obtained from normal healthy volunteers. We also compared 50 lymphoscintigraphies out of the previous 117 lipoedema patients before and six months after tumescent liposuction. Results In 117 lipoedema patients clearance 2 h post injection in the right and left foot was disturbed in 79.5 and 87.2% respectively. The inguinal uptake 2 h post injection in the right and left groin was disturbed in 60.3 and 64.7% respectively. In 50 lipoedema patients mean clearance and inguinal uptake after tumescent liposuction were slightly improved, 0.01 (p = 0.37) versus 0.02 (p = 0.02), respectively. This is statistically not relevant in clearance. Conclusion Lipoedema legs have a delayed lymph transport. Tumescent liposuction does not diminish the lymphatic function in lipoedema patients, thus tumescent liposuction can be regarded as a safe treatment.
... 3 This potentially aggressive disease is characterized by progressive enlargement of the lower body while the upper body remains relatively normal. 4 The disease eventuates in deformity, disability, and reduced quality of life. Current guidelines for treatment of lipedema exist Introduction Lipedema, also called lipoedema in Europe, is a chronic progressive disorder of subcutaneous adipose tissue usually affecting the lower extremities of women. ...
... Current guidelines for treatment of lipedema exist Introduction Lipedema, also called lipoedema in Europe, is a chronic progressive disorder of subcutaneous adipose tissue usually affecting the lower extremities of women. 4 The fat accumulations are unsightly and painful. First described by Allen and Hines 8 in 1940, the disease is infrequently diagnosed in the United States, although it is well-known in Europe. ...
Article
Background: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that usually affects the lower extremities of women. Also known as "two-body syndrome," the fat accumulations in lipedema are unsightly and painful. The disorder is well-known in Europe but is largely unrecognized and underdiagnosed in the United States. Objective: To hold the First International Consensus Conference on Lipedema with the purpose of reviewing current European guidelines and the literature regarding the long-term benefits that have been reported to occur after lymph-sparing liposuction for lipedema using tumescent local anesthesia. Methods: International experts on liposuction for lipedema were convened as part of the First International Congress on Lipedema in Vienna, Austria, June 9 to 10, 2017. Results: Multiple studies from Germany have reported long-term benefits for as long as 8 years after liposuction for lipedema using tumescent local anesthesia. Conclusion: Lymph-sparing liposuction using tumescent local anesthesia is currently the only effective treatment for lipedema.
... 11,12 Existem casos de lipedema em extremidade superior já descritos; nesses casos, a gordura acumula nos antebraços e braços poupando as mãos, simulando a aparência da distribuição da gordura nas pernas. [11][12][13][14] Áreas afetadas pelo lipedema frequentemente apresentam hematomas, dor e aumento de sensibilidade acompanhados por queixas sistêmicas de fadiga, diminuição de condição física e força muscular. Os sintomas frequentemente têm início durante a puberdade ou na faixa etária de adulto jovem, embora alguns pacientes possam iniciar os sintomas até mais tardiamente. ...
... indesign-lipedema-BR-PROCLIM-C16V3.indd14 14/05/2019 11:47:44 ...
Chapter
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INTRODUÇÃO Doenças que não possuem marcadores específicos, exames padrão ouro ou exames de imagem são muitas vezes desacreditadas. Para outras, cujo diagnóstico sempre foi clínico, passaram a ser necessários exames de imagem, para comprovar sua existência para o sistema de saúde. Com isso, os exames subsidiários muitas vezes passaram a ser reconhecidos como definitivos, e a importância da anamnese e exame físico são deixadas em um segundo plano. Doenças que apresentam variações clínicas amplas e não têm exames subsidiários definitivos são esquecidas. Para o generalista, a dificuldade no diagnóstico clínico é reconhecer condições que não se encaixam nas categorias de doenças familiares já conhecidas. O lipedema é uma delas. O lipedema foi descrito pela primeira vez em 1940, pelo Dr. Edgar Van Nuys Allen, cirurgião cardiovascular notabilizado pelo teste de Allen, e pelo Dr. Edgar Alphonso Hines Jr. na Mayo Clinic 1,2 na sessão Vascular clinics, hoje conhecida como síndrome de Allen-Hines. 3 Desde então, o lipedema foi caracterizado como uma deposição anormal de gordura em glúteos e pernas bilateralmente que pode ser acompanhada por edema ortostático. 1,2 ALEXANDRE CAMPOS MORAES AMATO DANIEL AUGUSTO BENITTI LIPEDEMA 9 | PROCLIM |
... The course of the disease is individual: some patients develop lipedema at a lower degree of severity and with stabilisation. Other patients show progression after stressful situations like pregnancy or surgery [12]. The onset of lipedema is common in teenage years, but is also observed after pregnancy or even menopause [3,13]. ...
... Originally developed for the treatment of lymphedema, improvement has also been seen in patients with lipedema (reduction in leg circumference, tension, and pressure pain). As the treatment success is short-term, therapy is permanently necessary [4,12]. ...
Article
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Background Lipedema is a chronic disorder of the adipose tissue that affects mainly women, characterised by symmetrical, excessive fatty tissue on the legs and pain. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial well-being, mobility and physical activity. Patients may benefit from surgical removal of abnormally propagated adipose tissue by liposuction. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT. Methods/design LIPLEG is a randomised controlled multicentre investigator-blinded trial. Women with lipedema ( n =405) without previous liposuction will be allocated 2:1 to liposuction or CDT. The primary outcome of the trial is leg pain reduction by ≥2 points on a visual analogue scale ranging 0–10 at 12 months on CDT or post-completion of liposuction. Secondary outcomes include changes in leg pain severity, health-related quality of life, depression tendency, haematoma tendency, prevalence of oedema, modification physical therapy scope, body fat percentage, leg circumference and movement restriction. The primary analysis bases on intention-to-treat. Success proportions are compared using the Mantel-Haenszel test stratified by lipedema stage at a 5% two-sided significance level. If this test is statistically significant, the equality of the response proportions in the separate strata is evaluated by Fisher’s exact test in a hierarchical test strategy. Discussion LIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues. The findings of this trial have the potential to change the standard of care in lipedema. Trial registration ClinicalTrials.gov NCT04272827. Registered on February 14, 2020. Trial status Protocol version is 02_0, December 17, 2019
... Positive family history has been reported in affected patients in values ranging between 16% and 64%. 3 Even so, given the lack of sufficient research, lipoedema is currently excluded from the list of hereditary diseases. ...
... In lipoedema, progression of the disease is excluded to the affected areas, mostly legs, whereas obesity affects the whole body and lymphoedema spreads proximally in most cases. 3 There is no response to dieting and minimal effect of elevation on oedema reduction in lipoedema. A physical examination reveals disproportion in body shape and a symmetrical bilateral enlargement of legs, hips and buttocks. ...
... Lipoedema neither includes any relevant oedema nor impairs the lymphatic system [1,120]. Furthermore, the efficacy of MLD has not been demonstrated in this condition [47,48]. Perceived pain reduction through the application of MLD may be helpful in the initial stages of treatment. ...
... Besides providing symptomatic relief, compression also supports the soft tissues, reduces the mechanical impairment of movement from skin lobes rubbing against each other, and improves mobility [47,48]. ...
Article
The four previous articles in this series addressed the myths and facts surrounding lipoedema. We have shown that there is no scientific evidence at all for the key statements made about lipoedema – which are published time and time again. The main result of this “misunderstanding” of lipoedema is a therapeutic concept that misses the mark. The patient’s real problems are overlooked. The national and especially the international response to the series, which can be read in both German and English, has been immense and has exceeded all our expectations. The numerous reactions to our articles make it clear that in other countries, too, the fallacies regarding lipoedema have led to an increasing discrepancy between the experience of healthcare workers and the perspective of patients and self-help groups, based on misinformation mostly generated by the medical profession. Parts 1 to 4 in this series of articles on the myths surrounding lipoedema have made it clear that we have to radically change the view of lipoedema that has been held for decades. Changing our perspective means getting away from the idea of “oedema in lipoedema” – and hence away from the dogma that decongestion is absolutely necessary – and towards the actual problems faced by our patients with lipoedema. Such a paradigm shift in a disease that has been described in the same way for decades cannot be left to individuals but must be put on a much broader footing. For this reason, the lead author of this series of articles invited renowned lipoedema experts from various European countries to discussions on the subject. Experts from seven different countries took part in the two European Lipoedema Forums, with the goal of establishing a consensus. The consensus reflects the experts’ shared view on the disease, having scrutinized the available literature, and having taken into account the many years of clinical practice with this particular patient group. Appropriate to the clinical complexity of lipoedema, participants from different specialties provided an interdisciplinary approach. Nearly all of the participants in the European Lipoedema Forum had already published work on lipoedema, had been involved in drawing up their national lipoedema guidelines, or were on the executive board of their respective specialty society. In this fifth and final part of our series on lipoedema, we will summarise the relevant findings of this consensus, emphasising the treatment of lipoedema as we now recommend it. As the next step, the actual consensus paper “European Best Practice of Lipoedema” will be issued as an international publication. Instead of looking at the treatment of oedema, the consensus paper will focus on treatment of the soft tissue pain, as well as the psychological vulnerability of patients with lipoedema. The relationship between pain perception and the patient’s mental health is recognised and dealt with specifically. The consensus also addresses the problem of self-acceptance, and this plays a prominent role in the new therapeutic concept. The treatment of obesity provides a further pillar of treatment. Obesity is recognised as being the most common comorbid condition by far and an important trigger of lipoedema. Bariatric surgery should therefore also be considered for patients with lipoedema who are morbidly obese. The expert group upgraded the importance of compression therapy and appropriate physical activity, as the demonstrated anti-inflammatory effects directly improve the patients’ symptoms. Patients will be provided with tools for personalised self-management in order to sustain sucessful treatment. Should conservative therapy fail to improve the symptoms, liposuction may be considered in strictly defined circumstances. The change in the view of lipoedema that we describe here brings the patients’ actual symptoms to the forefront. This approach allows us to focus on more comprehensive treatment that is not only more effective but also more sustainable than focusing on the removal of non-existent oedema.
... Lipoedema neither includes any relevant oedema nor impairs the lymphatic system [1,120]. Furthermore, the efficacy of MLD has not been demonstrated in this condition [47,48]. Perceived pain reduction through the application of MLD may be helpful in the initial stages of treatment. ...
... Besides providing symptomatic relief, compression also supports the soft tissues, reduces the mechanical impairment of movement from skin lobes rubbing against each other, and improves mobility [47,48]. ...
Article
Die Mythen und Fakten des Lipödems waren das Thema der vergangenen 4 Teile dieser Artikelserie. Wir konnten zeigen, dass für die zentralen – und immer wieder publizierten – Statements zum Lipödem keinerlei wissenschaftliche Evidenz vorliegt. Wesentliche Folge dieses „Fehlverständnisses“ der Erkrankung Lipödem ist ein Therapiekonzept, welches an den tatsächlichen Beschwerden der Patientinnen weitgehend vorbeigeht. Der nationale, aber vor allem auch der internationale Zuspruch, der auch in Englisch zu lesenden Reihe, war immens und übertraf all unsere Erwartungen. Die zahlreichen Reaktionen auf unsere Artikelserie machten eines deutlich: Auch in anderen Ländern führen die Stilblüten des Lipödems zu einer zunehmenden Diskrepanz zwischen den Erfahrungen der Behandler und der durch – meist ärztlich verursachten – Fehlinformation geleiteten Perspektive der Patientinnen und Selbsthilfegruppen. Die Teile 1 bis 4 der Artikelserie über die Mythen des Lipödems haben deutlich gemacht, dass wir diese seit Jahrzehnten tradierte Perspektive auf die Erkrankung Lipödem verändern müssen. Veränderung der Perspektive heißt: Weg vom „Ödem im Lipödem“, damit auch weg vom Dogma der notwendigen „Entstauung“ und hin zu den tatsächlichen Beschwerden unserer Lipödem-Patientinnen. Ein solcher Paradigmenwechsel eines seit Jahrzehnten auf immer gleiche Weise beschriebenen Krankheitsbildes kann nicht Aufgabe Einzelner sein, sondern muss auf breite Füße gestellt werden. Aus diesem Grund hat der ärztliche Erstautor dieser Artikelreihe renommierte Lipödem-Experten aus verschiedenen europäischen Ländern zu einer Diskussion über das Lipödem eingeladen. Ziel der beiden „European Lipoedema-Foren“, an denen Experten aus 7 Ländern teilnahmen, war die Erstellung eines Konsensus. Dieser Konsensus spiegelt unter Sichtung der zur Verfügung stehenden wissenschaftlichen Literatur – bei gleichzeitiger Berücksichtigung der jeweils langjährigen klinischen Arbeit mit diesen Patientinnen – die gemeinsame Sicht der beteiligten europäischen Experten auf diese Erkrankung wider. Der Komplexität des Krankheitsbildes Lipödem angemessen war auch die Struktur der Teilnehmer interdisziplinär. Nahezu alle Teilnehmer des European Lipoedema-Forum haben in der Vergangenheit entweder über das Lipödem publiziert bzw. an ihren nationalen Lipödem-Leitlinien mitgearbeitet oder sind in Vorständen ihrer Fachgesellschaften vertreten. In diesem fünften und letzten Teil unserer Artikelserie über das Lipödem sollen vorab die wesentlichen Ergebnisse dieses Konsensus kurz zusammengefasst werden, wobei der Fokus auf der empfohlenen Therapie des Lipödems liegt. Das eigentliche Konsensus-Papier, „European Best Practice of Lipoedema“, wird dann in einem zweiten Schritt im Rahmen einer internationalen Publikation veröffentlicht. Statt einer Ödem-Behandlung wird im Konsensus-Papier auf die Behandlung des Weichteilschmerzes ebenso fokussiert wie auf die psychische Vulnerabilität der Lipödem-Patientin. Zusammenhänge zwischen der Schmerzwahrnehmung und der psychischen Situation der Patientin werden anerkannt und gezielt behandelt. Hierbei wird auch das Problem der Selbstakzeptanz thematisiert und spielt im neuen Behandlungskonzept eine herausragende Rolle. Eine weitere Therapiesäule stellt die Adipositas-Behandlung dar. Adipositas wird somit als mit Abstand häufigste Begleiterkrankung – und wesentlicher Trigger – des Lipödems akzeptiert. Bei schwer adipösen Lipödem-Patientinnen sollte daher auch die bariatrische Operation erwogen werden. Kompressionstherapie und gezielte Bewegungsaktivität wurden von der Expertengruppe deutlich aufgewertet, da durch die nachgewiesenen antiinflammatorischen Effekte die Beschwerden der Patienten direkt verbessert werden. Durch ein individualisiertes Selbstmanagement werden den Patientinnen Tools mit an die Hand gegeben, die den Therapieerfolg nachhaltig stabilisieren. Sollte die konservative Therapie zu keiner relevanten Beschwerdebesserung führen, kann die Liposuktion unter Einhaltung klar definierter Vorgaben erwogen werden. Die hier beschriebene Veränderung der Perspektive auf das Lipödem stellt die tatsächlichen Beschwerden der Patientinnen in den Fokus. Dies ermöglicht eine umfassendere, damit bessere und auch nachhaltigere Behandlung als die Fokussierung auf ein nie nachgewiesenes Ödem und dessen Entstauung.
... The distribution of adipose tissue in lipoedema is always bilateral and symmetric, and feet remain unaffected [1,2,9,10]. Moreover, women with lipoedema experience painful ailments such as sensitivity on palpation, easy bruising and heaviness in the legs [6,11,12]. ...
Article
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(1) Background: Due to insufficient knowledge of lipoedema, the treatment of this disease is undoubtedly challenging. However, more and more researchers attempt to incorporate the most effective lipoedema treatment methods. When assessing a new therapeutic method, choosing correct, objective tools to measure the therapeutic outcome is very important. This article aims to present possible instruments that may be used in the evaluation of therapeutic effects in patients with lipoedema. (2) Methods: The data on therapeutic outcome measurements in lipoedema were selected in February 2022, using the Medical University of Gdansk Main Library multi-search engine. (3) Results: In total, 10 papers on this topic have been identified according to inclusion criteria. The tools evaluating the therapeutic outcomes used in the selected studies were: volume and circumference measurement, body mass index, waist-to-hip ratio, ultrasonography and various scales measuring the quality of life, the level of experiencing pain, the severity of symptoms, functional lower extremity scales, and a 6 min walk test. (4) Conclusion: The tools currently used in evaluating the effectiveness of conservative treatment in women with lipoedema are: volume and circumference measurement, waist-to-hip ratio, body fat percentage, ultrasonography, VAS scale, quality of life scales (SF-36, RAND-36), symptom severity questionnaire (QuASiL), Lower Extremity Functional Scale and 6 min walk. Choosing a proper tool to measure the treatment outcome is essential to objectively rate the effectiveness of therapeutic method.
... Lipedema consists of three stages characterized by the texture of skin and tissue formation: Stage 1 has normal smooth skin over pearl-sized nodules in a hypertrophic fat layer; Stage 2 has skin indentations over a hypertrophic fat structure of pearl to-apple-size masses; and Stage 3 has large extrusions of tissue causing skin and fat deformations mainly on the thighs and around the knees. [11][12][13][14]. Women with lipedema experience pain, heaviness of the affected limb, psychosocial distress, anxiety, eating disorders and the inability to lose weight as the fat tissue is highly resistant to diet and exercise [2,7,12,[15][16][17]. Symptoms may progress in the advanced stages of lipedema and are associated with increased cardiovascular and renal diseases [1,2]. ...
Article
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Lipedema is a painful loose connective tissue disorder characterized by a bilaterally symmetrical fat deposition in the lower extremities. The goal of this study was to characterize the adipose-derived stem cells (ASCs) of healthy and lipedema patients by the expression of stemness markers and the adipogenic and osteogenic differentiation potential. Forty patients, 20 healthy and 20 with lipedema, participated in this study. The stromal vascular fraction (SVF) was obtained from subcutaneous thigh (SVF-T) and abdomen (SVF-A) fat and plated for ASCs characterization. The data show a similar expression of mesenchymal markers, a significant increase in colonies (p < 0.05) and no change in the proliferation rate in ASCs isolated from the SVF-T or SVF-A of lipedema patients compared with healthy patients. The leptin gene expression was significantly increased in lipedema adipocytes differentiated from ASCs-T (p = 0.04) and the PPAR-γ expression was significantly increased in lipedema adipocytes differentiated from ASCs-A (p = 0.03) compared to the corresponding cells from healthy patients. No significant changes in the expression of genes associated with inflammation were detected in lipedema ASCs or differentiated adipocytes. These results suggest that lipedema ASCs isolated from SVF-T and SVF-A have a higher adipogenic differentiation potential compared to healthy ASCs.
... This hypothesis is based on single case reports; there are no valid data showing a significant increase of pro-inflammatory markers in patients with lipedema (15, e24-25). Disordered pain perception seems unlikely to be due to mechanical compression of nerve fibers by the expanding mass of fatty tissue and tissue edema, as there is no such disturbance in other types of lipohypertrophy or lymphedema (10). ...
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Background: Lipedema is often unrecognized or misdiagnosed; despite an estimated prevalence of 10% in the overall female population, its cause is still unknown. There is increasing awareness of this condition, but its differential diagnosis can still be challenging. In this article, we summarize current hypotheses on its pathogenesis and the recommendations of current guidelines for its diagnosis and treatment. Methods: This review is based on publications about lipedema that were retrieved by a selective search in the MEDLINE, Web of Science, and Cochrane Library data- bases. Results: The pathophysiology of lipedema remains unclear. The putative causes that have been proposed include altered adipogenesis, microangiopathy, and disturbed lymphatic microcirculation. No specific biomarker has yet been found, and the diag- nosis is currently made on clinical grounds alone. Ancillary tests are used only to rule out competing diagnoses. The state of the evidence on treatment is poor. Treatment generally consists of complex decongestive therapy. In observational studies, liposuction for the permanent reduction of adipose tissue has been found to relieve symptoms to a significant extent, with only rare complications. The statutory health- insurance carriers in Germany do not yet regularly cover the cost of the procedure; studies of high methodological quality will be needed before this is the case. Conclusion: The diagnosis of lipedema remains a challenge because of the hetero- geneous presentation of the condition and the current lack of objective measuring instru- ments to characterize it. This review provides a guide to its diagnosis and treatment in an interdisciplinary setting. Research in this area should focus on the elucidation of the pathophysiology of lipedema and the development of a specific biomarker for it.
... 10,11 Therapeutically, the most commonly applied therapy particularly in the later stages is the combined decongestive therapy, comprising manual lymphatic drainage and wearing of compression garments. 12 The most established surgical intervention to treat lipedema is liposuction/lipectomy. A number of studies released, show the beneficial effects of liposuction in a follow-up in up to 3 y postoperatively. ...
... There are distinctive criteria for lipedema which are absent in lymphedema including a negative Stemmer's sign, minimal pitting edema, thin skin, easy bruising, tenderness and pain [14, 39,40]. Although lymphatic microaneurysms might develop in the later stages of lipedema leading to secondary lymphedema, imaging techniques like high-resolution cutaneous ultrasonography and magnetic resonance imaging showed no defects in the lymphatic system in early stages [24,[41][42][43]. Other methods have also been successfully used to differentiate lipedema from lymphedema which includes tissue dielectric constant and dual-energy X-ray absorptiometry techniques [44][45][46][47][48]. ...
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Lipedema is a painful fat disease of loose connective tissue usually misdiagnosed as lifestyle-induced obesity that affects ~10% of women of European descent as well as other populations. Lipedema is characterized by symmetric enlargement of the buttocks, hips, and legs due to increased loose connective tissue; arms are also affected in 80% of patients. Lipedema loose connective tissue is characterized by hypertrophic adipocytes, inflammatory cells, and dilated leaky blood and lymphatic vessels. Altered fluid flux through the tissue causes accumulation of fluid, protein, and other constituents in the interstitium resulting in recruitment of inflammatory cells, which in turn stimulates fibrosis and results in difficulty in weight loss. Inflammation and excess interstitial substance may also activate nerve fibers instigating the painful lipedema fat tissue. More research is needed to characterize lipedema loose connective tissue structure in depth, as well as the form and function of blood and lymphatic vessels. Understanding the pathophysiology of the disease will allow healthcare providers to diagnose the disease and develop treatments. Keywords: lipedema, symptoms, diagnosis, treatment, blood vessels, lymphatics
... Im Gegensatz zu früheren Methoden der "dry technique" unter Vollnarkose bleiben bei der TLA-Methode Lymphgefäße sowie umliegende Strukturen funktionell und anatomisch intakt [23]. Unter Verwendung der TLA reichert sich die Tumeszenzlösung in den Fettzellen selbst an, wodurch das Gewebe an sich aufgelockert wird und anschließend stumpfe Mikrokanülen in Form der "wet technique" zum Einsatz kommen [24]. ...
... Moreover, people with lipedema are feeling rejected by medical personnel, because they are stigmatized as being obese [2]. This weight stigma and uncontrollable changes in body appearance over time will lead to learned helplessness, self-stigmatization, depression, anxiety, stress, feelings of shame and guilt, and body dissatisfaction [11][12][13][14]. In addition to the psychological and medical complications of lipedema mentioned above, these factors can increase the risk of depression, anxiety and eating disorders that further affect the QoL and the activity of daily living in people with lipedema [12,15]. ...
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Purpose The aim of this narrative review of the literature was to evaluate and summarize the current literature regarding the effect of lipedema on health-related quality of life (HRQOL) and psychological status. Methods The authors collected articles through a search into Medline, Embase, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cochrane Review. Search terms used included “Lipoedema,” “Lipedema,” “psychological status,” “Quality of life,” “Health related quality of life,” and “HRQOL.” Results A total of four observational studies were evaluated. The included studies were moderate-quality according to the Newcastle–Ottawa Scale. Three of the included studies demonstrated deterioration of HRQOL and psychological status in patients with lipedema. These studies also identify that pain and tenderness are a more common and dominant characteristic. Conclusion Future studies should establish a specific approach to treat and manage lipedema symptoms. Based on this narrative review of the literature findings, we recommended for the health care provider to pay more attention to HRQOL and psychological status. Moreover, validated and adapted measures of HRQOL and psychological status for patients with lipedema are required. Level of evidence Level V, narrative review.
... 5 In contrast to lymphedema, it does not usually affect either the feet or the lower part of the ankle, being abruptly detained at the ankle joint (Fig. 1); this is called the "cuff sign" or the "bracelet effect" or the "handcuffs" in the case of the arms. 6 Edema of the lower limbs usually worsens in the evening and at night in relation to orthostatism and heat. Patients also complain of increased sensitivity to pain and a tendency to develop subcutaneous bruises with only minimum trauma. ...
Article
Introduction: Lipedema is a syndrome that is characterised by edema, an accumulation of fat, pain and haematomas in the lower limbs that principally affects women. Diagnosis is currently based on clinical criteria, since there is no accurate diagnostic imaging for the condition. The aim of our study was to describe the lymphoscintigraphic findings in patients with lipedema. Material and method: A prospective cohort study of women with clinical criteria of lipedema who underwent lymphoscintigraphy. Two independent nuclear physicians described and classified the lymphoscintigraphy findings in different grades of severity, according to the migration and distribution of the radiopharmaceutical. Eighty three patients were included with a median age of 49.7 years (range: 18-80) and a mean body mass index (BMI) of 29.9 kg/m2 (95% CI: 28.4-31.3) Results: Lymphoscintigraphy showed alterations in 47% of the patients, most were low (35.9%) or low-moderate grade (48.7%). None of the patients were severely affected (no migration of the radiopharmaceutical). The degree of lymphoscintigraphic involvement bore no relation to age (P = .674), Stemmer’s sign (P = .506), or BMI (P = .832). We found lymphoscintigraphy findings in all the clinical stages of lipedema, with no significant differences between the grade of lymphoscintigraphic involvement and the clinical stage of lipedema (P = .142). Conclusion: Although lymphoscintigraphy has been used to differentiate lipedema from lymphedema, we found frequent alterations in the patients with lipedema, therefore the presence of findings does not rule out the diagnosis of lipedema.
... Las pacientes presentan un aumento simétrico y anormal de tejido adiposo en caderas, muslos y piernas; y en un tercio afecta también a los miembros superiores 5 . A diferencia del linfedema, no suele afectar a los pies ni a la parte baja del tobillo, deteniéndose abruptamente en la articulación del tobillo (Figura 1a), este signo se denomina "cuff sign", del grillete o de las esposas en el caso de los brazos 6 aparecen son: la alteración del arco plantar, frialdad cutánea, y dolor espontáneo. Cuando el lipedema progresa y se acompaña de importante volumen, la dificultad para caminar incapacita la vida del paciente y con frecuencia se asocia a artrosis en caderas y rodillas. ...
Article
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Introduction: Lipedema is a syndrome that is characterised by edema, an accumulation of fat, pain and haematomas in the lower limbs that principally affects women. Diagnosis is currently based on clinical criteria, since there is no accurate diagnostic imaging for the condition. The aim of our study was to describe the lymphoscintigraphic findings in patients with lipedema. Material and method: A prospective cohort study of women with clinical criteria of lipedema who underwent lymphoscintigraphy. Two independent nuclear physicians described and classified the lymphoscintigraphy findings in different grades of severity, according to the migration and distribution of the radiopharmaceutical. Eighty three patients were included with a median age of 49.7years (range: 18-80) and a mean body mass index (BMI) of 29.9kg/m2 (95%CI: 28.4-31.3) RESULTS: Lymphoscintigraphy showed alterations in 47% of the patients, most were low (35.9%) or low-moderate grade (48.7%). None of the patients were severely affected (no migration of the radiopharmaceutical). The degree of lymphoscintigraphic involvement bore no relation to age (P=.674), Stemmer's sign (P=.506), or BMI (P=.832). We found lymphoscintigraphy findings in all the clinical stages of lipedema, with no significant differences between the grade of lymphoscintigraphic involvement and the clinical stage of lipedema (P=.142). Conclusion: Although lymphoscintigraphy has been used to differentiate lipedema from lymphedema, we found frequent alterations in the patients with lipedema, therefore the presence of findings dues not discount a diagnosis of lip1aedema.
... Different studies have postulated a correlation of the onset and progression of lipedema with microangiopathy, lymphangiopathy, adipocyte hyperplasia/hypertrophy, tissue hypoxia, fibrosis, and macrophage infiltration, without the causal triggering factors being found or the pathophysiological significance of the hormones being clarified [13][14][15][16][17][18][19]. Microangiopathy associated with the fat growth very early in the disease might lead to a disruption of the endothelial barrier function and to an increase in the permeability of the capillaries [14,20]. ...
Article
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Lipedema is a chronic, progressive disease of adipose tissue with unknown etiology. Based on the relevance of the stromal vascular fraction (SVF) cell population in lipedema, we performed a thorough characterization of subcutaneous adipose tissue, SVF isolated thereof and the sorted populations of endothelial cells (EC), pericytes and cultured adipose-derived stromal/stem cells (ASC) of early-stage lipedema patients. We employed histological and gene expression analysis and investigated the endothelial barrier by immunofluorescence and analysis of endothelial permeability in vitro. Although there were no significant differences in histological stainings, we found altered gene expression of factors relevant for local estrogen metabolism (aromatase), preadipocyte commitment (ZNF423) and immune cell infiltration (CD11c) in lipedema on the tissue level, as well as in distinct cellular subpopulations. Machine learning analysis of immunofluorescence images of CD31 and ZO-1 revealed a morphological difference in the cellular junctions of EC cultures derived from healthy and lipedema individuals. Furthermore, the secretome of lipedema-derived SVF cells was sufficient to significantly increase leakiness of healthy human primary EC, which was also reflected by decreased mRNA expression of VE-cadherin. Here, we showed for the first time that the secretome of SVF cells creates an environment that triggers endothelial barrier dysfunction in early-stage lipedema. Moreover, since alterations in gene expression were detected on the cellular and/or tissue level, the choice of sample material is of high importance in elucidating this complex disease.
... Participants with lipedema met all primary criteria (positive diagnosis, bilateral orthostatic leg swelling, negative Stemmer sign) and one or more secondary criterion (lower extremity pain, family history of lipedema, joint hypermobility, easy leg bruising, and/or nonpitting leg edema). Participants with lipedema were staged according to clinical standards (18). All participants rated their experience of leg pain on a normal day using the 100-point visual analog scale (VAS). ...
Article
Objective Lipedema is characterized by pain, fatigue, and excessive adipose tissue and sodium accumulation of the lower extremities. This case‐control study aims to determine whether sodium or vascular dysfunction is present in the central nervous system. Methods Brain magnetic resonance imaging was performed at 3 T in patients with lipedema (n = 15) and control (n = 18) participants matched for sex, age, race, and BMI. Standard anatomical imaging and intracranial angiography were applied to evaluate brain volume and vasculopathy, respectively; arterial spin labeling and sodium magnetic resonance imaging were applied to quantify cerebral blood flow (CBF) (milliliters per 100 grams of tissue/minute) and brain tissue sodium content (millimoles per liter), respectively. A Mann‐Whitney U test (significance criteria P < 0.05) was applied to evaluate group differences. Results No differences in tissue volume, white matter hyperintensities, intracranial vasculopathy, or tissue sodium content were observed between groups. Gray matter CBF was elevated (P = 0.03) in patients with lipedema (57.2 ± 9.6 mL per 100 g/min) versus control participants (49.8 ± 9.1 mL per 100 g/min). Conclusions Findings provide evidence that brain sodium and tissue fractions are similar between patients with lipedema and control participants and that patients with lipedema do not exhibit abnormal radiological indicators of intracranial vasculopathy or ischemic injury. Potential explanations for elevated CBF are discussed in the context of the growing literature on lipedema symptomatology and vascular dysfunction.
... Unterstützendaber nicht ersetzend für manuelle Lymphdrainage (MLD) und Kompressionist auch die apparative intermittierende Kompression (AIK) wirksam [15,26,35,36]. ...
Article
Zusammenfassung Die zunehmende Prävalenz des Lipödems geht einher mit einer demografischen Zunahme der Adipositas per magna. Konservative und operative Maßnahmen ermöglichen eine ausgeprägte Befund- und Beschwerdebesserung. Die exakte Diagnose und Differenzierung zwischen therapiebedürftiger Adipositas und therapiebedürftigem Lipödem entscheiden über Erfolg und Misserfolg der eingeleiteten Therapie. Nach konservativem Therapieversuch kann die operative Versorgung bei Ausbleiben einer entsprechenden Besserung durch Liposuktion oder adipositaschirurgische Intervention bei einem erheblichen Teil der Betroffenen die konservative Therapie reduzieren bzw. teilweise sogar ganz überflüssig machen.
... lipedema had a negative effect on quality of life (QoL). Since it is unknown what is causing the pain, an optimal and effective treatment is unclear (12,13). Today's treatment options consist of conservative physical therapy, surgical liposuction and lifestyle modifications, including altering dietary intake and increasing physical activity (7). ...
Article
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Background: Lipedema is an underdiagnosed condition in women, characterized by a symmetrical increase in subcutaneous adipose tissue (SAT) in the lower extremities, sparing the trunk. The lipedema SAT has been found to be resistant to diet, exercise and bariatric surgery, in regard to both weight loss (WL) and symptom relief. Current experience indicates that a low carbohydrate and high fat (LCHF-diet) might have a beneficial effect on weight and symptom management in lipedema. Objective: To assess the impact of an eucaloric low carbohydrate, high fat (LCHF)-diet on pain and quality of life (QoL) in patients with lipedema. Methods: Women diagnosed with lipedema, including all types and stages affecting the legs, (age 18-75 years, BMI 30-45 kg/m2) underwent 7 weeks (wk) of LCHF-diet and, thereafter 6 wk of a diet following the Nordic nutrition recommendations. Pain (visual analog scale) and QoL (questionnaire for lymphedema of the limbs), weight and body composition were measured at baseline, wk 7 and 13. Results: Nine women (BMI: 36.7±4.5kg/m2 and age: 46.9±7 years) were recruited. The LCHF diet induced a significant WL -4.6±0.7 kg (-4.5±2.4%), P<0.001 for both, and reduction in pain (-2.3±0.4 cm, P=0.020). No correlation was found between WL and changes in pain at wk 7 (r = 0.283, P = 0.460). WL was maintained between wk 7 and 13 (0.3±0.7 kg, P=0.430), but pain returned to baseline levels at wk 13 (4.2±0.7 cm ,P=0.690). A significant increase in general QoL was found between baseline and wk 7 (1.0 (95% CI (2.0, 0.001), P=0.050) and 13 (1.0 95% CI (2.0, 0.001) P=0.050), respectively. Conclusion: A LCHF-diet is associated with reduction in perceived pain and improvement in QoL, in patients with lipedema. Larger randomized clinical trials are needed to confirm these findings.
... Clinical and surgical treatments for lipedema have been described extensively in international guidelines. The aim of all of these is to improve the signs and symptoms, to reduce volumes and disproportions of the affected limbs, and to prevent progression [14][15][16][17][18]. Manual lymphatic drainage and elastic compression have been reported to alleviate symptoms [5]. ...
Article
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BACKGROUND Lipedema is a chronic progressive disease characterized by the abnormal accumulation of fat in the subcutaneous region. Both medical and surgical treatments have been described in international guidelines; however, the current literature is biased toward promoting liposuction as the primary treatment of lipedema, and this can lead to the misapprehension that liposuction is the only form of definitive treatment. CASE REPORT In the present study, we report 5 cases at various stages of the evolution of lipedema, all with different therapeutic objectives. Case 1 reported having persistent bruising and pain, case 2 reported pain and fat deposition, case 3 reported night cramps and discomfort, case 4 reported leg thickening, and case 5 reported redness in the legs. All of were diagnosed with lipedema in different evolution stages. Our purpose was to demonstrate the possibility of non-surgical therapy, as well as to improve signs and symptoms of lipedema, using the QuASiL questionnaire and measuring changes in volumes and proportions. Good aesthetic outcomes improve both social and psychological status. CONCLUSIONS Currently, there are many described therapies available for lipedema. Liposuction surgery for lipedema should be considered one possible tool. Treatment objectives can be different for each patient. It is imperative to understand each patient's needs in order to offer the best therapy attainable that meets patient requirements and induces a better quality of life. Non-surgical treatment of lipedema is feasible in selected cases, and it can meet the criteria for achieving selected clinical objectives.
... The prevalence of lipoedema in the general public is also unknown, and the data from many sources in this regard is widely divergent [9,12,13]. There is also a lack of systematic knowledge of the diagnostic criteria, which often leads to incorrect diagnosis [14]. Difficulties in diagnosis result in a delay or absence of targeted treatment, which results in a much more severe course of the disease leading to disability [1,4,15,16]. ...
Article
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(1) Background: Lipoedema is a disease characterized by excessive bilateral and symmetrical accumulation of subcutaneous tissue in the lower extremities. It is a poorly understood condition, and low awareness of its existence often leads to incorrect diagnosis Initially, lipoedema was considered to be completely independent of lifestyle Currently, however, more and more cases of the coexistence of lipoedema and obesity are described in the literature as additionally affecting the severity of the disease The aim of the review is to present lipoedema as a social problem. (2) Methods: Materials on lipoedema in the social context were selected from 2018–2021. The PRISMA-Scr checklist was used in the review. (3) Results: Research has shown that more than 3/4 of patients with lipoedema are also overweight or obese. Patients with lipoedema have many comorbidities, and their presence negatively affects the quality of life. The quality of life in patients with lipoedema is lower than in healthy patients. (4) Conclusions: The number of studies available on lipoedema is low. Obesity is common in patients with lipoedema. Mental disorders increase the level of experienced pain. Lipoedema significantly reduces quality of life. A healthy lifestyle in patients with lipoedema could be helpful for prevention of complications and disability.
... Large variability in the natural history of lipedema is noted. While some patients develop only mild lipedema, which does not progress with the time, others show gradual and slow progression (28,29). This point should be further investigated. ...
Article
Lipedema is a chronic disease seen frequently in women that causes abnormal fat deposition in the lower limbs and associated bruising and pain. Despite increasing knowledge concerning lipedema, there are still aspects of diagnosis that need further investigation. We performed a prospective, observational cohort study to describe prevalence of clinical characteristics present in patients with lipedema in an attempt to establish diagnostic criteria. Participants were consecutive patients with lipedema presenting at a public hospital in Spain from September 2012 to December 2019. Patients were examined for the following signs and symptoms of lipedema: symmetrical involvement; disproportion between the upper and lower part of the body; sparing of the feet; pain; bruising; Stemmer' sign; pitting test; fibrosis; venous insufficiency; upper limbs involvement; vascular spiders; skin coldness; and lymphangitis attacks. In addition, orthopedic alterations were examined in all patients. We recruited 138 patients (median age=47.6 years; mean BMI=29.9 Kg/m2). Using waist-to-height-ratio, 41.3% of the patients were slim or healthy. The most frequent type of lipedema was Type III (71%), and most were in stage 1 and 2. The features of lipedema with a prevalence >80% were symmetrical involvement, unaffected feet, pain, bruising, vascular spiders, and disproportion. Pain was nociceptive in 60.2% and neuropathic in 33.1%, and there was a reduced social or working activities in 37.9%. Orthopedic alterations including cavus-feet or valgus-knees were observed in 1/3 of the patients. X-ray of the knees was performed in 63 patients and knee osteoarthritis diagnosed in 37. We found that the most frequent manifestations of lipedema were bilateral involvement, unaffected feet, pain, easy bruising, vascular spiders, and disproportion between the upper and lower parts of the body. These should be considered as major criteria for diagnosis. In addition, our findings on the prevalence of orthopedic alterations in patients with lipedema highlights the need for a multidisciplinary and integrated approach. https://journals.librarypublishing.arizona.edu/lymph/article/id/4838/
... 9 Pregnancy, stress and regular use of oral contraceptive pills are found to play important role in the development of lipedema. 10 Some of the cases have positive family history. Usually involves lower limbs also upper limbs in rare cases. ...
Article
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Lipedema is a clinical condition in which there is abnormal swelling of body parts which may be confused with lymphedema and obesity. Allen and Hines first coined this term in 1940. It commonly affects lower limbs in symmetrical pattern. However asymmetric lipedema cases are reported also. Women are commonly affected. Diagnosis is mostly clinical. Imaging has important role in diagnosis and differentiating from closely related differentials. Conservative and surgical treatment are usually recommended. It is often misdiagnosed due to lack of proper knowledge and investigated in an inappropriate way. Here, we report a 36–years–old woman presenting with unilateral thigh swelling for 1 year. She had localized lipedema of left thigh and was advised for consultation with plastic surgery department
... Individual audio-taped interviews were conducted during 2019 using a qualitative and narrative interview approach (cf. Kvale & Brinkmann, 2009). Two of the authors performed the data collection, and interviewed half of the group each. ...
Article
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Lipedema is a chronic, progressive disease that almost exclusively affects women and often misdiagnosed as obesity or primary lymphedema. Research concerning lipedema is sparse, and there is a lack of studies focusing on women’s experiences of living with the illness. We interviewed fourteen women with lipedema with the aim of describing their experiences of living with lipedema. Our results show that women felt controlled by their body, and were fat-shamed and viewed by others as a person who lacked character. They received unsupportive advice on how to manage from healthcare, and blamed themselves while striving to take responsibility.
... Además del edema de los pies, con un signo de Stemmer positivo patognomónico, la etapa 4 puede ir acompañada de otras características comunes del linfedema avanzado, como celulitis a repetición o papilomatosis. Generalmente, la progresión de la enfermedad es heterogénea y muy variable, ya que algunas mujeres desarrollan lipedema leve y estable en el tiempo, mientras que otras muestran una progresión gradual con exacerbación repentina inducida por factores estresores (por ejemplo, embarazo o cirugías) 23 . ...
Article
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El lipedema es una enfermedad común, frecuentemente sub-diagnosticada, crónica y progresiva, que genera un gran deterioro en la calidad de vida. Consiste en el depósito anormal de tejido adiposo subcutáneo principalmente en las extremidades inferiores, afectando casi exclusivamente a mujeres. Sus síntomas principales son el dolor, la sensibilidad y la facilidad para producir equimosis. Desde el punto de vista fisiopatológico, existiría una susceptibilidad poligénica combinada con trastornos hormonales, microvasculares y linfáticos que pueden ser en parte responsables del desarrollo del lipedema. Se clasifica, según la distribución de la grasa en cinco tipos y, según la gravedad de la enferemdad, en cuatro etapas. El diagnóstico es eminentemente clínico y se debe diferenciar de otras patologías que producen aumento de volumen de las extremidades, especialmente el linfedema y obesidad. Es importante realizar un estudio funcional del sistema linfático cuando el diagnóstico es dudoso o para la etapificación del lipedema, por lo que la correcta interpretación de estos resultados es fundamental. El tratamiento está enfocado en disminuir la discapacidad y evitar la progresión, con el fin de mejorar la calidad de vida. Actualmente la liposucción es un tratamiento efectivo para el lipedema, sin embargo, las técnicas empleadas para la lipectomía en el lipedema son diferentes a las técnicas utilizadas para la liposucción con fines estéticos. Las técnicas selectivas que respetan los vasos linfáticos tienen mejor rendimiento para reducir el volumen de grasa, retrasar la progresión, reducir el dolor, reducir la alteración marcha y mejorar la calidad de vida en estos pacientes.
... In a typical presentation of lipedema, the enlargement of the lower extremities is disproportionately greater than that of the trunk and upper extremities. 1 The feet are not involved and the arms are less commonly affected. The swelling does not improve with elevation or weight loss. 2 When first described in 1940, lipedema was thought to exclusively affect the lower extremities. ...
Article
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Objective: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on upper extremity circumference and volume in patients with lipedema. Methods and Results: All participants included in the study were included in a treatment protocol consisting of CDP and IPC. The Perometer 400 NT was used in the measurement of upper extremity volume and circumference before and after treatment. The measurements were performed in four reference points. According to the Perometer results before and after CDP, statistically significant reduction was found in the circumference of 3 of the 4 points of measurements performed in each of the left and right upper extremities. When the volume assessments were compared, it was seen that statistically significant reduction was found in the volume of both limbs. Conclusion: A treatment program consisting of CDP and IPC can be effective in reducing the circumference and volume of the arm in patients with upper extremity lipedema. So, CDP applications can help prevent the development of complications such as lipolymphedema, hypertension, and heart failure. Clinical Trial Registration number: NCT04643392 https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AF9B&selectaction=Edit&uid=U00055NT&ts=2&cx=-3oevdw.
... A recent study of the signs and symptoms of patients with LI found that 89.7% reported daily pain in LAT [23]. LI-associated pain can be severe, and a factor in worsening QoL and loss of mobility [24]. In an internet survey of 120 women with LI, all but seven reported that pain was a daily concern, and 66% described their pain as moderate or severe [8]. ...
... There are publications saying that the use of MLD is not indicated in lipedema because there is no lymphatic disorder. 20,21 In contrast, when literature is examined, studies that have shown the benefit of MLD can also be found. Bilancini et al. showed that lymphatic drainage was reduced in lipedema patients compared with healthy subjects. ...
Article
Background: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on lower extremity limb circumference and volume in patients with lipedema. Methods and Results: In measurement of limb volume and circumference measurement, the Perometer 400 NT was used before and after treatment. The perometer measurements in this study were performed in the certain five reference points (cB, cC, cD, cE, and CF). All participants included in the study were included in a treatment protocol consisting of CDP and IPC. It was seen that statistically significant reduction was found in the circumference of 3 of the 5 points of measurements performed in the left limb, whereas statistically significant reduction was found in the circumference of 4 of the 5 points of measurements performed in the right limb. When the assessments of limb volume performed with the perometer were compared before and after CDP, it was seen that statistically significant reduction was found in the volume of both limbs. Conclusion: This reduction indicates that CDP is effective in the treatment of lower extremity lipedema. Clinicaltrials.gov with an ID of NCT04492046.
... A recent study of the signs and symptoms of patients with LI found that 89.7% reported daily pain in LAT [23]. LI-associated pain can be severe, and a factor in worsening QoL and loss of mobility [24]. In an internet survey of 120 women with LI, all but seven reported that pain was a daily concern, and 66% described their pain as moderate or severe [8]. ...
Article
Full-text available
Lipedema (LI) is a common yet misdiagnosed condition, often misconstrued with obesity. LI affects women almost exclusively, and its painful and life-changing symptoms have long been thought to be resistant to the lifestyle interventions such as diet and exercise. In this paper, we discuss possible mechanisms by which patients adopting a ketogenic diet (KD) can alleviate many of the unwanted clinical features of LI. This paper is also an effort to provide evidence for the hypothesis of the potency of this dietary intervention for addressing the symptoms of LI. Specifically, we examine the scientific evidence of effectiveness of adopting a KD by patients to alleviate clinical features associated with LI, including excessive and disproportionate lower body adipose tissue (AT) deposition, pain, and reduction in quality of life (QoL). We also explore several clinical features of LI currently under debate, including the potential existence and nature of edema, metabolic and hormonal dysfunction, inflammation, and fibrosis. The effectiveness of a KD on addressing clinical features of LI has been demonstrated in human studies, and shows promise as an intervention for LI. We hope this paper leads to an improved understanding of optimal nutritional management for patients with LI and stimulates future research in this area of study.
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Lipedema is a condition where there is abnormal, increased deposition of adipose tissue in the subcutaneous tissues. This distinct clinical entity was initially described by Allen and Hines, affecting the lower limbs. The longstanding and progressive nature of this disease condition often results in discomfort, pain, and disfiguration, which can affect an individual’s quality of life. There is a preponderance of women compared to men and most frequently affecting the age groups from puberty to mid-30s. Lipedema can affect both lower and upper limbs (in 30% of cases) with symmetrical bilateral distribution. One particular distinguishing feature is sparing of the hands and feet which is seen in lipedema as compared to lymphedema. Due to the misdiagnosis of lipedema as obesity or lymphedema, the true prevalence is significantly under-reported. Although the precise prevalence is evasive, it is estimated that 1 in 10 women can develop lipedema. As such by the time the diagnosis has been obtained, chronic irreversible changes such as pain, tightness, bruising tendency are already present, which result in significant challenges to effective treatment.
Article
Lipedema, the Unknown Abstract. Lipoedema patients suffer from the widespread ignorance of their pathology. Considering its chronic, progressive and invalidating character, the early diagnosis of the disease must constitute the challenge of their caregivers in order to limit medical wanderings and the occurrence of complex clinical pictures. Treatments allow the reduction of lipedema and its long-term control. Management must be individualized according to the stage of the disease. The adherence of the patient, the supervision and the support of the practitioner are essential for obtaining the best results.
Chapter
Fatty tissue is part of the connective tissue and is found almost everywhere in the body. Essentially, it serves as an energy store, offers protection against heat loss and performs mechanical tasks. Panniculitides are a broad group of inflammatory diseases of the subcutaneous fat with heterogeneous etiology. Patients often have uncharacteristically indurated erythematous nodules that may or may not be related to generalized symptoms. A diagnosis can often be achieved by histological analysis of a deep biopsy. By far the most common form of panniculitis is erythema nodosum, which is more common than all other forms of panniculitis taken together. Other panniculitides may develop consequent to infections, after physical injuries such as exposure to cold temperature, as part of different autoimmune diseases such as lupus erythematosus and rheumatoid arthritis, or as reactions to various drugs. Some other rare forms of panniculitides develop particularly in young children. This chapter also discusses the various forms and diseases accompanied by lipoatrophy and lipodystrophy.
Article
Lipedema is a fat disorder that is often misdiagnosed. It was first identified at the Mayo Clinic in 1940, but medical schools do not include it in their curriculum and is therefore poorly understood. It presents as disproportionate and symmetrical accumulations of fat (bilateral), which is often accompanied by orthostatic edema. Early diagnosis and treatment are crucial, as the disease is progressive and can lead to immobility as well as a significant decrease in the quality of life. Lipedema differs from obesity because it does not respond to diet and exercise. This article gives you a glimpse into what lipedema is about and will help you identify some differences between lipedema and lymphedema. It will also help you identify which surgical procedures have been successful in treating the disease.
Article
Lipedema is a chronic, progressive disorder of adipose tissue, found almost exclusively in women, that involves disproportionate subcutaneous fat depositions, leading to progressive and symmetric enlargement of the legs. The condition usually appears at puberty or in the third decade of life. Many patients report a family history of such disorder. The diagnosis is usually based on the physical examination and medical history. If left untreated, lipedema may result in secondary lymphatic dysfunction, physical impairment and mental problems, leading to significant damage to patient’s quality of life. The condition is frequently misdiagnosed as lymphedema or mistreated as obesity. Other than that, the differential diagnosis includes chronic venous insufficiency, constitutional variability of the legs, lipohypertrophy, Dercum’s disease, Madelung’s disease. The treatment options include diet and compression therapy, conservative treatment of secondary edema and surgical interventions. There is an urgent need for further studies on the pathogenesis of lipedema, epidemiology, diagnostic criteria and possible curative treatment.
Chapter
This chapter addresses principally non‐inflammatory acquired disorders of subcutaneous fat with an emphasis on acquired lipodystrophy, fat hypertrophy, subcutaneous lipomatosis and lipoedema. While some of the entities discussed are very common, such as cellulite and obesity, most are much rarer. Panniculitis and genetic disorders of subcutaneous fat are addressed other chapters in the book.
Article
Currently, the ketogenic diet (KD) is used to treat obesity. A prospective study on the use of KD and nutraceutical correction of the nutritional status of patients with lipedema was carried out. Aim. To study the effect of the ketogenic diet, accompanied by correction of changes in the intestinal microbiome and hepatoprotection,on the reduction of fatty deposits in lipedema and the dynamics of changes in lipid and carbohydrate metabolism hormones. Material and methods. 60 patients with lower limb lipedema of stages I-III were randomized into 2 groups: Group 1 received a lowcalorie diet (LCD), physical exercises in the gym (PE), and physical activity (FA) in the form of daily walking up to 3-5 km/ day. Group 2 received a modified version of the Atkins ketogenic diet, physical exercises in the gym and FA, as well as nutraceutical correction of increased appetite, probiotic intestinal composition, hepatoprotection. The duration of the treatment course was 4 weeks. Anthropometric methods and bioimpedansometry were used to control limb circumferences, waist and thigh. Results and discussion. After treatment, patients in 1st group showed a decrease in body weight, lean and active cell mass, a decrease in musculoskeletal mass, and a decrease in total water due to extracellular water. A decrease in total cholesterol and high density lipoproteins (HDL) fraction, an increase in blood triglyceride fraction was noted. Leptin decreased by 12.73%. Patients of the 2nd group showed a decrease in body weight, fat mass, lean mass, total water and extracellular water. There was a decrease in total cholesterol, triglycerides, transaminases. Leptin decreased by 32.02%, insulin decreased by 9.87%. To prevent the development of fatty hepatosis against the background of the use of KD, patients of the 2nd group received nutraceutical correction: hepatoprotector Gepamin, metaprebiotic Stimbifid-plus, modulating the formation of resident intestinal microbiota. To reduce appetite, the patients of the 2nd group were also prescribed anorexic - an algal product Nativ containing the polysaccharide fucoidan, having a prebiotic effect. Improvement of reparative processes in the liver, suppression of oxidative processes also contributed to the restoration of the sensitivity of insulin receptors, which was confirmed by the normalization of the lipid-carbohydrate spectrum of blood in patients of the 2nd group after the course of the treatment. The insulin decrease in patients of Group 2 indicated not only insulin resistance decrease , but also the lipogenesis decrease and stimulation of lipolysis. Adipose tissue reduction due to lipolysis stimulation was also indicated by a decrease in leptin expression. Conclusion. Thus, a ketogenic diet, accompanied by nutraceutical correction of the intestinal microbiome and hepatoprotection can be effectively used in combination with physical activity in order to reduce body weight, fat mass and edema, as evidenced by a decrease in the expression level of leptin and insulin, correlating with the levels of fat loss and free water.
Article
Background: Lipedema is characterized by localized accumulation of fat in the extremities, which is typically unresponsive to dietary regimes or physical activity. Although the disease is well described and has a high incidence, little is known regarding the molecular and cellular mechanisms underlying its pathogenesis. The aim of this study was to investigate the pathophysiology of lipedema adipose cells in vitro. Methods: Adipose stem cells (ADSCs) were isolated from lipoaspirates derived from lipedema and non-lipedema patients undergoing tumescent liposuction. In vitro differentiation studies were performed for up to 14 days using adipogenic or regular culture medium. Supernatants and cell lysates were tested for adiponectin, leptin, insulin-like growth factor-1 (IGF-1), aromatase (CYP19A1), and interleukin-8 (IL-8) contents at days 7 and 14, using enzyme-linked immunosorbent assays (ELISAs). Adipogenesis was evaluated by visualizing and measuring cytoplasmic lipid accumulation. Results: Lipedema ADSCs showed impeded adipogenesis already at early stages of in vitro differentiation. Concomitantly with a strongly reduced cytoplasmic lipid accumulation, significantly lower amounts of adiponectin and leptin were detectable in supernatants from lipedema ADSCs and adipocytes compared to control cells. Additionally, lipedema and non-lipedema cells differed in their expression of IGF-1, aromatase (CYP19A1), IL-8 and in their proliferative activity. Conclusion: Our findings indicate that in vitro adipogenesis of lipedema ADSCs is severely hampered in comparison to non-lipedema ADSCs. Lipedema adipose cells not only differ in their lipid storage capacity but also in their adipokine expression pattern. This might serve as a valuable marker for diagnosis of lipedema, probably from an early stage on.
Article
Background: Lipedema is a distinct adipose disorder from obesity necessitating awareness as well as different management approaches to address pain and optimize quality of life (QoL). The purpose of this proof-of-principle study is to evaluate the therapeutic potential of physical therapy interventions in women with lipedema. Methods and Results: Participants with Stage 1-2 lipedema and early Stage 0-1 lymphedema (n = 5, age = 38.4 ± 13.4 years, body mass index = 27.2 ± 4.3 kg/m2) underwent nine visits of physical therapy in 6 weeks for management of symptoms impacting functional mobility and QoL. Pre- and post-therapy, participants were scanned with 3 Tesla sodium and water magnetic resonance imaging (MRI), underwent biophysical measurements, and completed questionnaires measuring function and QoL (patient-specific functional scale, PSFS, and RAND-36). Pain was measured at each visit using the 0-10 visual analog scale (VAS). Treatment effect was calculated for all study variables. The primary symptomatology measures of pain and function revealed clinically significant post-treatment improvements and large treatment effects (Cohen's d for pain VAS = -2.5 and PSFS = 4.4). The primary sodium MRI measures, leg skin sodium, and subcutaneous adipose tissue (SAT) sodium, reduced following treatment and revealed large treatment effects (Cohen's d for skin sodium = -1.2 and SAT sodium = -0.9). Conclusions: This proof-of-principle study provides support that persons with lipedema can benefit from physical therapy to manage characteristic symptoms of leg pain and improve QoL. Objective MRI measurement of reduced tissue sodium in the skin and SAT regions indicates reduced inflammation in the treated limbs. Further research is warranted to optimize the conservative therapy approach in lipedema, a condition for which curative and disease-modifying treatments are unavailable.
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Lipedema is a chronic adipose tissue disorder characterized by the disproportional subcutaneous deposition of fat and is commonly misdiagnosed as lymphedema or obesity. The molecular determinants of the lipedema remain largely unknown and only speculations exist regarding the lymphatic system involvement. The aim of the present study is to characterize the lymphatic vascular involvement in established lipedema. The histological and molecular characterization was conducted on anatomically-matched skin and fat biopsies as well as serum samples from eleven lipedema and ten BMI-matched healthy patients. Increased systemic levels of vascular endothelial growth factor (VEGF)-C (P = 0.02) were identified in the serum of lipedema patients. Surprisingly, despite the increased VEGF-C levels no morphological changes of the lymphatic vessels were observed. Importantly, expression analysis of lymphatic and blood vessel-related genes revealed a marked downregulation of Tie2 (P < 0.0001) and FLT4 (VEGFR-3) (P = 0.02) consistent with an increased macrophage infiltration (P = 0.009), without changes in the expression of other lymphatic markers. Interestingly, a distinct local cytokine milieu, with decreased VEGF-A (P = 0.04) and VEGF-D (P = 0.02) expression was identified. No apparent lymphatic anomaly underlies lipedema, providing evidence for the different disease nature in comparison to lymphedema. The changes in the lymphatic-related cytokine milieu might be related to a modified vascular permeability developed secondarily to lipedema progression.
Article
Le lipœdème est une entité clinique mal connue, dont la prévalence est inconnue et qui est souvent confondue avec un lymphœdème. Il s’agit d’une répartition anormale du tissu adipeux, également pathologique, allant des hanches jusqu’aux chevilles en respectant les pieds. Il touche presque exclusivement les femmes obèses et débute généralement vers la puberté. Il s’accompagne de douleurs spontanées cutanées ou lors d’une stimulation modérée (pression, pincement), d’ecchymoses spontanées et d’œdèmes après orthostatisme prolongé. Le retentissement sur l’image corporelle et sur la qualité de vie est très important. Les examens complémentaires (scanner, IRM, lymphoscintigraphie) peuvent être utiles en cas de doute diagnostique ou pour confirmer le lipœdème. Après une longue évolution, le système lymphatique est atteint avec l’apparition d’un lipolymphœdème touchant alors le dos du pied et pouvant se compliquer d’érysipèle. La prise en charge n’est pas codifiée et comprend une perte de poids (qui améliore peu la morphologie des membres inférieurs), un soutien psychologique, la compression élastique, souvent mal tolérée et les activités physiques, en particulier en milieu aquatique. La liposuccion par tumescence réduit le volume, les douleurs spontanées et provoquées, les ecchymoses spontanées, et améliore l’apparence mais aussi la qualité de vie. La poursuite de la recherche clinique et physiopathologique du lipœdème est nécessaire pour pouvoir prendre en charge les femmes qui en sont atteintes.
Article
Lipedema is a chronic, progressive disease marked by abnormal fat distribution in the limbs, resulting in disproportionately sized and painful limbs. It primarily affects women and causes significant disability, functional impairment, and psychological distress. Despite its clinical significance in women’s health, lipedema is largely unknown, underdiagnosed, and misdiagnosed with other diseases with similar symptoms including obesity. It is difficult to distinguish between obesity and lipedema since these two conditions often coexist. Since the precise etiology of lipedema is yet to be determined, there is no treatment that targets the underlying cause. The most basic conservative treatment is decongestive physical therapy, which is normally needed life-long. In some cases, surgical procedures such as liposuction and excisional lipectomy are the therapeutic alternatives. Lipedematous scalp is a rare, dermatological condition with no known cause, characterized by increased subcutaneous tissue thickness and a smooth and boggy scalp. When it occurs in conjunction with alopecia, it is known as lipedematous alopecia, often mistaken as androgenetic alopecia. The goals of this article are to explain the etiology, clinical features, and treatment options for lipedema and lipedematous scalp (two relatively less known conditions), as well as to highlight their diagnostic features.
Article
Lipedema is a fat disorder that is often misdiagnosed. It was first identified at the Mayo Clinic in 1940, but medical schools do not include it in their curriculum and is therefore poorly understood. It presents as disproportionate and symmetrical accumulations of fat (bilateral), which is often accompanied by orthostatic edema. Early diagnosis and treatment are crucial, as the disease is progressive and can lead to immobility as well as a significant decrease in the quality of life. Lipedema differs from obesity because it does not respond to diet and exercise. This article gives you a glimpse into what lipedema is about and will help you identify some differences between lipedema and lymphedema. It will also help you identify which surgical procedures have been successful in treating the disease.
Chapter
Das Fettgewebe ist Teil des Bindegewebes und kommt fast überall im Körper vor. Im Wesentlichen dient es als Energiespeicher, bietet Schutz vor Wärmeverlust und erfüllt mechanische Aufgaben. Das subkutane Fettgewebe liegt zwischen Dermis und Muskelfaszien, Sehnen und Ligamenten. Augenlider und das männliche Genitale weisen keine Fettschicht auf. Die Stärke des subkutanen Fettgewebes ist an den verschiedenen Körperregionen unterschiedlich und wird von Geschlecht, Alter, genetischer Prädisposition, endokrinen und metabolischen Faktoren beeinflusst. Die Subkutis besteht aus Fettgewebsläppchen, die durch Bindegewebssepten getrennt werden, in denen sich Arterien, Venen und Lymphgefäße befinden. Die kleinste funktionelle Einheit ist der Mikrolobulus, welcher eine kleine Gruppe von Adipozyten umschließt, die von einer Arteriole versorgt werden. Das Fettgewebe synthetisiert und sezerniert physiologisch und bei Krankheitsprozessen eine ganze Reihe von Proteinen (Adipokine), zum Beispiel Leptin, Adiponektin, IL-6, und TNF-α, die insbesondere bei der Adipositas und Insulinresistenz von Bedeutung sind. Diese Adipokine haben meist proinflammatorische Eigenschaften.
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The case of a 22-year-old patient who suffered from lipoedema of the lower limbs and underwent aesthetic surgery for varicose veins is reported. After surgery the patient started to present a sensation of heaviness, oedema and tiredness of the limbs. It was observed that the haematomas took about eight months to disappear. The diameter of the legs increased by 4 centimetres in this period. The aim of this publication is to warn about this happening in patients suffering from lipoedema who are then submitted to varicose vein surgery. Key words:
Article
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To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs. CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primary lymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement. Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema. Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.
Article
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As the science of wound healing has evolved over the past two decades, so has awareness of the "hidden epidemic" of lymphedema. Substantial information has been accumulated regarding the pathophysiology and therapy of lymphedema. Until recently, the relationship between wound healing and the negative effects of associated peri-wound lymphedema has received little attention. Identifying wound-related lymph stasis and safe mobilization of the fluid are fundamentals that must be addressed for proper therapy. Experience gained from the successful treatment of primary and secondary lymphedema has proven very useful in the applications to wound-related lymphedema. The mobilization of lymph fluid from the peri-wound area with the use of reasoned compression is essential for proper therapy of the open wound, as are appropriate bandage selection and safeguards for bandage application.
Article
Zusammenfassung Fragestellung: Die Lymphszintigraphie wird fast ausschließlich als qualitative Untersuchung durchgeführt. Diese Tatsache erfüllt nicht die lymphologische Forderung nach einer Funktionsdiagnostik zur Abklärung lymphostatischer Ödeme der Extremitäten. Eine zusätzliche quantitative Untersuchung ist deshalb unbedingt erforderlich. In diesem Zusammenhang wurde die Notwendigkeit einer Schwächungskorrektur und Methoden der Lymphknotentiefenbestimmung sowie die Verbesserung der körperlichen Belastung während der Untersuchung bestimmt und ein standardisiertes Untersuchungsprotokoll erarbeitet. Methoden: Subkutane Injektion (in Fuß oder Hand) von 37 MBq 99mTc-Nanokolloid bei 924 Patienten. Kontinuierliche Erfassung des Uptakes in den regionalen Lymphknoten während körperlicher Belastung (1 h) mit unterschiedlichen Belastungsverfahren. Bei der Uptakeberechnung wird eine Schwächungskorrektur durchgeführt; die Ergebnisse nach Lymphknotentiefenbestimmung mit SPECT (Single Photon Emission Computed Tomography) werden im Vergleich mit der sonographischen Tiefenbestimmung sowie mit Uptakeberechnung ohne Schwächungskorrektur diskutiert. Ergebnisse: Der Vergleich der Belastungsformen zeigt, dass nur das kontrollierte Gehen eine zuverlässige Belastung gewährleistet. Ein Vergleich der Uptakewerte nach sonographischer Lymphknotentiefenbestimmung gegenüber der SPECT ergibt beträchtliche Fehler bei der sonographischen Methode. Der Verzicht auf eine Schwächungskorrektur schließt eine quantitative Untersuchung aus. Die genaueren Messverfahren eröffnen neue pathophysiologische Aspekte beim Lipödem und Lipolymphödem. Schlussfolgerungen: Kontrolliertes Gehen und tiefenkorrigierte Lymphknotenuptakewerte sind unverzichtbare Voraussetzungen für zuverlässige Ergebnisse bei der Funktionslymphszintigraphie.
Article
Liposuction in tumescence local anesthesia (TLA) with vibrating microcannulas (power assisted liposuction, PAL) has proved as save and effective treatment for lipoedema. Own experiences with actually 11 patients showed very good improvement with normalization of body shape. Additionally, pain disappeared in all patients, proness to bruising in many of them. Complications like damage of lymphatic vessels with increase of oedema, as described in former publications, could not be observed. Because of the obtained results liposuction should be considered as a very successful treatment for patients with lipoedema.
Article
Purpose: Assessment of the relation between age and lymph transport in lipedema patients using lymphoscintigraphic function test. Material and methods: 99mTc human serum nanocolloid (37 MBq) was injected subcutaneously into the dorsum of foot (n = 290 feet) in female patients suffering of lipedema, lipolipedema or patients with normal lymph transport. Patients were enrolled in standardized exercise tasks. For the radioisotope uptake calculation regional lymph nodes depth was determined by SPECT (single photon computed tomography). Results: The lymph node uptake of young patients (until 35 years) reaches higher values than the normal collective and decreases significantly with age until it drop's below the normal collective. Conclusions: The lymphoscintigraphic function test of the legs showed an increased transport function of the epifascial lymphatic system by younger and a decreased transport function by elder patients with lipedema compared to the normal population, the high transport values suggest a high lymphatic volume with compensatory capacity increase of the lymphatic system in young patients. According to these results of the lymphatic transport function the age of the patients has to be regarded.
Article
Zusammenfassung Ziel: Die lymphatische Insuffizienz könnte bei dem fast ausschließlich bei Frauen auftretenden Lipödem pathophysiologisch eine bedeutende Rolle spielen. Über die Pathophysiologie dieser abnorm lokalisierten Körperfettablagerungen ist wenig bekannt. Untersucht wurde die Beteiligung des Lymphsystems bei Lipödem vom Typ Allen-Hines sowie bei Typus Rusticanus-Moncorps. Patienten, Methoden: Bei 28 Patienten mit Lipödem wurden die Standard-Lymphszintigraphie (epifaszial) und eine modifizierte Lymphszintigraphie (subkutan) durchgeführt. Die prozentualen Uptakes in Relation zur injizierten Dosis dienten als funktionale quantitative Parameter. Beide Studien wurden visuell bewertet. Patienten mit Ödemen der Beine infolge Veneninsuffizienz (Stadium II nach Widmer) dienten als Kontrollgruppe. Ergebnisse: Die Standard-Lymphszintigraphie zeigte bei allen Patienten der Kontrollgruppe sowie allen Patienten mit Lipödem vom Typ Rusticanus-Moncorps einen normalen Befund hinsichtlich der visuellen Bewertung und des quantitativen Wertes. Der Lymphtransport aus dem subkutanen Fettgewebe war im Patientenkollektiv mit Lipödem vom Typ Allen-Hines signifikant höher (p <0,012) als beim Typus Rusticanus-Moncorps. Schlussfolgerungen: Die epifasziale Lymphdrainage bei Patienten mit Lipödem ist nicht signifikant gestört. Die subkutane Lymphdrainage bei Patienten mit Lipödem vom Typ Rusticanus-Moncorps unterschied sich jedoch deutlich von der bei Patienten mit Lipödem vom Typ Allen-Hines, was auf eine unterschiedliche lymphatische Pathophysiologie hindeutet.
Article
Aim: Lymphoscintigraphy is commonly performed as a qualitative diagnotic study with visual interpretation of images. However, quantitative lymphoscintigraphy is the only functional test of the lymphatic system to obtain accurate information about lymph transport in lymphedema patients. Since attenuation correction and type of exercise may vary, heterogeneous data are the result. Here we compare different methods and derive a standardized protocol resulting in highly reproducible data. Patients and methods: Tc-99m-marked human serum nanocolloid (37 MBq) was injected subcutaneously into the back of foot or hand (924 patients). Patients were enrolled in standardized exercise tasks and radioisotope uptake into regional lymph nodes was determined. Using ultrasound or SPECT to localize the lymph node, we determined best attenuation correction. Results: Reliable and comparable results were achieved by using a treadmill ergometer to standardize exercise. SPECT was superior compared to ultrasound in detemining the correct depth of lymph nodes and in deriving the correct attenuation correction, which is essential in quantitating lymphatic function accurately. Conclusions: Standardization of exercise and attenuation correction are essential in performing functional lymphoscintigraphy. We show that systematic errors are reduced to a great extent by using the developed optimized protocol.
Article
A 22 yr old woman with bilateral symmetrical enlargement of her lower extremities since the age of 11 is reported. A diagnosis of lipedema of the legs was made on the basis of history, physical examination, biopsy and phlebography. Lipedema of the legs should be included in the differential diagnosis of symmetrical nonpitting edematous lower extremities. According to Allen and Hines, the characteristic points to be made for a diagnosis of lipedema of the legs included the following: almost exclusively seen in women; always bilateral and symmetrical with minimal involvement of the feet; minimal to absent pitting edems; all parts of the limbs are involved simultaneously; persistent enlargement despite elevation of the extremities. 16% of their patients gave a family history of the disorder; 40% complained of pain in the lower extremities; and approximately half of the patients were obese. The age of onset was variable, from childhood to the sixth or seventh decade. There was no racial preponderance. No patient gave a history compatible with progressive lipodystrophy. Treatment included diet, diuretics, tight stockings, rest and elevation, and massage, but was unsatisfactory in most cases.
Article
Forty patients with atypical, chronically swollen, painful lower extremities were observed from two to ten years. Most patients had had previous diagnoses of lymphostasis or venostasis. Clinical reevaluation indicated lipedema (painful fat syndrome) as described by Allen and Hines in 1940 and not reported on since.Fourteen patients were selected at random for detailed pathologic and chemical (tissue and serum) examinations as well as flow studies in the lymphatic, venous, and arterial systems. All study results were essentially normal except for chemical examinations. Significant amounts of lipids containing an altered fatty acid pattern were found in plasma and tissue examined by biopsy.(JAMA 228:1656-1659, 1974)
Article
Aufgrund des lebenslangen, meist progredienten Verlaufs und des ausgeprägten Leidensdrucks ist das Lipödem ein wichtiges dermatologisches Krankheitsbild. Durch die vor Jahren als Standardbehandlung eingeführte Komplexe Physikalische Entstauungstherapie lässt sich eine deutliche Abnahme der krankheitstypischen Ödeme erzielen. Als neues effektives Verfahren hat sich die Liposuktion in Tumeszenz-Lokalanästhesie mit vibrierenden Mikrokanülen erwiesen. Eine gezielte und dauerhafte Reduktion der unproportionierten Fettgewebsanteile verhilft den Betroffenen aufgrund des verbesserten Aussehens, der Ödemreduktion und der Schmerzbeseitigung zu einer ausgeprägten Verbesserung der Lebensqualität. Because of the lifelong and often progressive course and the mental trauma to the patients, lipoedema is an important dermatologic disorder. Complex physical therapy programs were introduced as a standard therapy years ago and can achieve an impressive oedema reduction. Liposuction in tumescent local anesthesia with vibrating microcannulas has proved to be a new effective treatment. A targeted and permanent reduction of the fat tissue leads to an increased quality of life due to an improved appearance, reduced tendency to swelling and less pain.
Article
Lipedema is characterized by bilateral enlargement of the legs due to abnormal deposition of fat tissue from pelvis to ankles. It is seen most frequently in obese women. Lipedema appears to be a distinct clinical entity but may be confounded with lymphedema.
Article
The worldwide incidence of lymphedema has become a "hidden epidemic." Until recent years, this important disease process and its complication morbidity, has received little clinical attention. The pathophysiology, diagnoses and treatment of lymphedema and lipedema are discussed in this article. Peri-wound lymph stasis is shown to be a major inhibitory factor in the wound healing process. Therefore, the integration of lymphedema therapy and basic wound care has important clinical significance. Compression is the cornerstone of wound related lymphedema. The fundamentals and clinical safety guidelines for applying compression are presented.
Article
Durch korrekten Einsatz der Tumeszenztechnik kann die Liposuktionschirurgie als ein risikoarmes Operationsverfahren eingestuft werden, bei dem durch kombinierten Einsatz moderner Instrumente und Operationstechniken ein weitgehend vorhersagbares, sthetisch sehr zufrieden stellendes Resultat erzielt werden kann. Neue Indikationen fr die Liposuktionschirurgie sind das Lipdem und die Cellulite. Als besonders schonend hat sich die vibrationsassistierte Liposuktion (VAL) erwiesen. Der durch Erhalt des Bindegewebes induzierte Wundheilungsverlauf fhrt dazu, dieses Verfahren auch als Korrektureingriff zu empfehlen. Eigenfetttransplantationen haben sich einen festen Platz unter den Augmentationsverfahren gesichert. Hier bietet sich das Verfahren des Liporecycling mit Wiederverwendung des im Rahmen einer Reduktionsliposuktion gewonnenen Materials an. Neue Aspekte der Injektionstechnik sind die Mikrodropletmethode, flchige Injektionstechniken und die Beachtung eines 3-dimensionalen Gewebeaufbaues.Through the appropriate use of tumescent anesthesia and the use of modern instruments and techniques, liposuction surgery has become a low-risk procedure which produces predictable and aesthetically pleasing results. New indications for liposuction surgery include lipedema and cellulite. Vibration-assisted liposuction has proven to be especially gentle to the tissues. The induced tissue contraction helps to create better results in correction procedures after less-than-satisfactory liposuction. Autologous fat transfer is also firmly established as an augmentation procedure. In liporecycling, the fat obtained during reduction liposuction is used elsewhere for augmentation. New approaches in fat transfer include the microdroplet technique, flatter injection approaches and three-dimensional tissue augmentation.
Article
The authors assessed the use of magnetic resonance imaging in differentiating lymphedema, phlebedema, and lipedema of the lower limb. They examined 14 patients: five with lipedema, five with lymphedema, and four with phlebedema. T1- and T2-weighted transaxial sequences were performed before administration of gadolinium tetraazacyclododecane-tetraacetic acid (DOTA) and T1-weighted spin-echo sequences were performed after administration of Gd-DOTA in each patient. Images of patients with lipedema showed homogeneously enlarged subcutaneous layers, with no increase in signal intensity at T2-weighted imaging or after Gd-DOTA administration. Patients with phlebedema had areas containing increased amounts of fluid within muscle and subcutaneous fat. In lymphedema, a honeycomb pattern above the fascia between muscle and subcutis was observed, with a marked increase in signal intensity at T2-weighted imaging. After Gd-DOTA administration, there was only a slight increase in signal intensity in the subcutis in lymphedema and phlebedema and a moderate increase in signal intensity in muscle in phlebedema.
Article
An overall view of the clinical findings in lipedema is given and of its treatment. Lipedema is shown to be a distinct illness, and not just a disturbance of the distribution pattern of subcutaneous fatty tissue. The diagnosis is based on an accurate history and specific criteria on clinical examination and palpation.
Article
Using the tumescent technique, liposuction can remove large volumes of fat with minimal blood loss. A maximal safe dosage of dilute lidocaine using the tumescent technique is estimated to be 35 mg/kg. The slow infiltration of a local anesthetic solution of lidocaine and epinephrine minimizes the rate of systemic absorption and reduces the potential for toxicity. Dilution of lidocaine (0.05% of 0.1%) and epinephrine (1:1,000,000) further delays absorption and reduces the magnitude of peak plasma lidocaine concentrations. Using the tumescent technique for liposuction, peak plasma lidocaine levels occur 12 hours after the initial injection. Clinically significant local anesthesia persists for up to 18 hours. For liposuction, it is not necessary to use local anesthetics, which are longer acting and potentially more cardiotoxic than lidocaine.
Article
To evaluate the deciding diagnostic criteria of indirect lymphography in lymphoedema of the leg, 91 investigations were reviewed. 72 examinations were from lymphoedematous legs as judged by clinical appearance and isotopic lymphography and 19 from healthy legs. After subepidermal infusion of adequate water soluble contrast media (e.g. Jotrolan) in healthy legs, 17 from 19 cases showed normal ellipsoid dye-deposits with normally structured lymph-collectors. In two cases pathological lymph-collectors were shown (specificity 89%). In the 72 legs with lymphoedema the most prominent pathological features were altered lymph-collectors and/or dermal backflow. Only two cases revealed a normal pattern (Sensitivity 97%). Indirect lymphography therefore may be recommended as a sensitive but less specific diagnostic tool for proving lymphoedema in a suspected clinical situation.
Article
The use of a single axial slice through the mid calf in the differential diagnosis of a swollen leg is described. This is a very simple quick non-invasive investigation. Venous obstruction results in an increase in the cross sectional area of the muscle compartment. The subcutaneous fat layer is normally homogeneous; in obesity or lipoedema it is increased but remains homogeneous. In lymphoedema fluid collects in the interstitial spaces which become very prominent on CT images. In chronic lymphoedema a honeycomb pattern is seen as a result of increase in the interstitial tissue due to fibrosis. Popliteal cyst extensions result in fluid collections between muscle planes. Haematomas have higher attenuation, and are intramuscular. The findings in 64 patients and 10 controls are presented and the literature is reviewed.
Article
Indirect lymphography by subepidermal infusion of newly developed nonionic, dimeric contrast media (e.g., Iotrolan) opacifies peripheral lymphatics of the skin. Using this method we examined 159 patients with primary and secondary lymphedema, chronic venous insufficiency, and lipedema and compared the findings to normal individuals. A variety of characteristic patterns were uncovered. The technique causes little patient discomfort and takes on the average only 30 minutes.
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Article
Lipedema is a hereditary disease concerning exclusively women. We discuss the characteristics of diagnosis as well as the differential diagnosis between lipedema and primary lymphedema. Therapy is effective if the lipedema resembles a lymphedema.
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Twelve patients with primary lymphedema of the lower limb were examined with computed tomography (CT). A characteristic "honeycomb" pattern of the subcutaneous compartment was seen in 10 of these patients. CT scans in nine other patients with swollen leg secondary to chronic venous disease or lipedema did not show this characteristic pattern. CT may be helpful in the differential diagnosis of a swollen leg, thus obviating venography or lymphangiography.
Article
1. Lipoedema is described with an illustration of a recent case. 2. This condition should be distinguished from lymphoedema of the legs. 3. The differential diagnosis is discussed. 4. Comment is made on treatment.
Article
Two cases of lipedema are presented. They illustrate this clinical syndrome which occurs almost exclusively in women and presents as grossly enlarged legs, thighs and buttocks. The etiology remains uncertain. Although infrequently diagnosed, lipedema is not rare. We report success treating such patients with properly measured and fitted compression garments.
Article
Patients with lipoedema of the typus rusticanus Moncorps show a skin elasticity deficit of the skin of the calf. This is partly due to the derma oedema in the skin of these patients and seems partly to be due to an intrinsic connective tissue defect in the skin of such patients. The auteurs put forward the hypothesis that also present calf muscle pump dysfunction in these patients is the result of a connective tissue defect of the fascia of the muscular compartment, as an expression of a more generalized connective tissue defect.
Article
Lipedema of the legs is a symmetrical thickening of upper and lower leg and topically accentuated fat pads. The back of the foot is usually free of swelling. Pathogenetically it is a disturbance of the distribution pattern of subcutaneous fat tissue. Epidemiologically, the subjects affected are women, starting from puberty. Weight reduction programs do not influence the real deformations. If this abnormal fat tissue is infiltrated by angiological diseases, these manifest themselves in modified form. In particular, all the symptoms are more painful. In arterial ischemic syndromes that taut skin is susceptible to necrosis at atypical locations. For reconstruction of trunk arteries it is advisable to bypass larger bulges for better wound nealing. Venous strips should be peeled out away from fat pads and venous-bridges very carefully to protect the tissue. Acute and chronic phlebothrombosis lead to unusual and asymmetrical forms of swelling. The venous ulcer lies directly beneath a fat-muff in the gaiter region. Since they are hard to compress, free skin transplants should be considered early in the course of development. Surgery of varicose veins calls for most careful technique to ensure wound healing. From the lymphological viewpoint there are clinically and lymphographically mixed forms of lymphedema with lipedema.
Article
PURPOSE: To enhance the learner's competence in caring for patients with lipedema through understanding the differential diagnoses, pathophysiology, and treatment/management options. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: 1. Differentiate lipedema from other similar diagnoses. 2. Tell patients with lipedema and their caregivers about treatment of this condition. 3. Construct assessments, treatment plans, and management options for patients with lipedema.
Article
Lipedema is a chronic vascular disease almost exclusively of female sex, characterized by the deposit of fat on the legs, with an "Egyptian column" shape, orthostatic edema, hypothermia of the skin, alteration of the plantar support, and negativity of Stemmer's sign. The etiology and pathogenesis of this disease are still the object of study, and therapy is very difficult. Various authors have described morphologic and functional alterations of prelym phatic structures and of lymphatic vessels. The big veins remain untouched in the phlebograms and an alteration of the skin elasticity is demonstrated. The present authors have studied by dynamic lymphoscintigraphy 12 women patients suffering from lipedema, and compared the results with those of 5 normal subjects and 5 patients suffering from idiopathic lymphedema who were sex and age matched with the patients suffering from lipedema. The patients suffering from lipedema showed an abnormal lymphoscintigraphic pattern with a slowing of the lymphatic flow that presented some analogies to the alter ations found in the patients suffering from lymphedema. A frequent asymmetry was also noticed in the lymphoscintigraphic findings that is in contrast to the symmetry of the clinical profile.
Article
In a review of 250 cases of lymphedema of the lower extremity, 9 patients were noted to share unique similarities in their history and physical findings. Although these patients had mild swelling in their pretibial areas and were all referred with a diagnosis of lymphedema of the legs, their findings differed significantly from the usual patient with either congenital or acquired lymphedema. Notably, the lower extremity swelling was always bilateral and symmetrical in nature and never involved the feet. Skin changes characteristic of lymphedema were not found, and consistent fat pads were present anterior to the lateral malleoli in each patient. These findings are representative of a clinical entity known as lipedema, which is distinct from lymphedema and for which treatment may be different.
Article
Edemas of the leg sometimes pose problems for diagnosis. Invasive procedures like lymphography or phlebography are either difficult to perform or might endanger the lymphatics. The value of magnetic resonance imaging was assessed in 20 patients with lymphedema, lipedema and phlebedema. Images of patients with lipedema showed homogenous enlarged subcutaneous tissue. In lymphedema a honeycomb pattern in the subcutaneous tissue was observed; in phlebedema there was an increase of fluid within the muscle. Magnetic resonance imaging is useful in differentiating lymphedema, lipedema or phlebedema.
Microlymphatics of human skin form two superposed networks. The superficial one located at the level of dermal papillae may be visualized by fluorescence microlymphography. Microlymphatics fill from a subepidermal depot of minute amounts of FITC-dextran 150,000. In primary lymphedema with late onset the depicted network with vessels of normal size is significantly larger than in healthy controls, whereas in congenital lymphedema (Milroy's disease) microlymphatics are aplastic or ectatic (diameter > 90 microns). Lymphatic microangiopathy with obliterations of microvessels develops in chronic venous insufficiency, in lipedema (preliminary results) and after recurrent erysipelata. In healthy controls microlymphatics are permeable to FITC-dextran 40,000 and impermeable to the larger molecule 150,000. Preserved fragments of the network in chronic venous insufficiency exhibit increased permeability to FITC-dextran 150,000. After visualization of the vessels by the fluorescent dye microlymphatic pressure may be measured by the servo-nulling technique. First results indicate that microlymphatic hypertension contributes to edema formation in patients with primary lymphedema.
Article
Early terms of lymphostasis in lipedema can be detected with lymphoscintigraphy. A normal examination almost certainly excludes a lymphatic component. Indirect lymphography is only used to rule out morphological abnormalities of lymph vessels. If a lymphoscintigraphic study is normal indirect lymphography is not indicated.
Article
Lipoedema is a common but infrequently recognized condition causing bilateral enlargement of the legs in women. Although generally considered to be the result of an abnormal deposition of subcutaneous fat with associated oedema, the precise mechanisms responsible for oedema formation have yet to be fully established. In order to evaluate the possible role of lymphatic or venous dysfunction in the pathogenesis of lipoedema, 10 patients were investigated by photoplethysmography (venous function) and quantitative lymphoscintigraphy (lymphatic function). The results were compared with those from patients with primary lymphoedema and those from healthy volunteers. The results demonstrated minor abnormalities of venous function in only two patients. One patient had moderately impaired lymphatic function in both legs and seven patients had a marginal degree of impairment in one or both legs. However, in none of these cases did the impairment attain the low levels seen in true lymphoedema. Lipoedema appears to be a distinct clinical entity best classified as a lipodystrophy rather than a direct consequence of any primary venous or lymphatic insufficiency.
Article
Twenty-four healthy subjects and 16 patients with lymphedema and lipedema were studied with MRI and ultratomography. In chronic lymphedema, ultrasonography revealed a statistically significant increase of the subcutaneous fat without difference in skin thickness as compared to the healthy subjects. MRI revealed in lymphedema a statistically significant increase of skin thickness + subcutaneous tissue + muscular mass (p = 0.048); in lipedema, a statistically significant increase of skin thickness and subcutaneous tissue (p < 0.0001) as compared to the healthy controls. MRI offers strong qualitative and quantitative parameters in the diagnosis of lymphedema and lipolymphedema, while ultrasonography is expected to improve its diagnostic efficiency with the aid of high frequency echo with more sophisticated resolution apparatus. Age, weight and height of the patient as well as duration of the disease do not seem to affect the above-mentioned parameters.