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Lipedema

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Lipedema
Other names: Lipoedema, lipödem, lipalgia, adiposalgia, adipoalgesia, adiposis dolorosa, lipomatosis dolorosa of the legs, lipohypertrophy dolorosa, painful column leg, painful lipedema syndrome
Lipedema, type III, stage 1.
SpecialtyVascular medicine
SymptomsIncreased fat under the skin of the legs, easy bruising, pain[1]
ComplicationsDepression[1]
Usual onsetPuberty, pregnancy, menopause[1]
DurationLong-term[2]
CausesUnknown[1]
Risk factorsAffected family member[3]
Diagnostic methodBased on symptoms and examination[1]
Differential diagnosisPedal edema, lymphedema, obesity[1][4]
TreatmentDiet, exercise, compression stockings, liposuction[1][3]
FrequencyUp to 11% of women[5]

Lipedema is an enlargement of both legs due to increased fat under the skin, which is disproportional in nature.[1][3] Pain and easy bruising may also occur and symptoms generally worsen with time.[1] The feet are generally not affected; though occasionally the arms are.[3] Women of any weight may have the condition.[3] Complications may include depression.[1]

While the cause is unknown, it is believed to involve genetics and hormonal factors.[1] It often runs in families.[1] At least initially the lymphatic system is normal.[2] Diagnosis is based on symptoms and examination.[1] Other conditions that are similar include pedal edema and lymphedema.[1] It is commonly misdiagnosed as obesity.[4]

While there is no cure; treatment may help.[3] This may include a healthy diet and exercise to maintain a healthy weight; thought, the condition is often resistant to weight loss.[3][1] Compression stockings may help with pain and the ability to walk.[3] Liposuction can help in severe symptoms.[3][1]

Lipedema is estimated to affect up to 11% of women in the United States.[5] It occurs almost only in women.[1] Onset is typically during puberty, pregnancy, or menopause.[1] The condition was first described in 1940, with the first criteria for diagnosis set in 1951.[5]

Signs and symptoms

The presentation of this condition is consistent with: loose skin, bruising, and unusual fat deposits in legs[6]

  • Lipoedema stage I
    Lipoedema stage I
  • Lipoedema stage II
    Lipoedema stage II
  • Lipoedema stage III
    Lipoedema stage III

Associations

Depression and anxiety are common for a variety of reasons, particularly the fact that diagnosis usually takes a long time and people have received much advice on diet and exercise, neither of which are very effective for the lipedema although they may help associated conditions.[7] Joint pain, arthritis, dry skin, fungal infections, cellulitis and slow wound healing.[8]

Diagnosis

Severity

Lipedema is classified by stage: Stage 1: Normal skin surface with enlarged hypodermis (lipedema fat). Stage 2: Uneven skin with indentations in fat and larger hypodermal masses (lipomas). Stage 3: Bulky extrusions of skin and fat cause large deformations especially on the thighs and around the knees. These large extrusions of tissue drastically inhibit mobility.[9][10]

Differential

Lipedema is often underdiagnosed due to the difficulty in differentiating it from lymphedema, obesity, or other edemas.[11]

Lipo-lymphedema

Lipo-lymphedema, a secondary lymphedema, is associated with both lipedema and obesity (which occur together in the majority of cases), most often lipedema stages 2 and 3.[12]

Dercum's disease

Lipedema / Dercum's disease differentiation – these conditions may co-exist. Dercum's disease is a syndrome of painful growths in subcutaneous fat. Unlike lipedema, which occurs primarily in the trunk and legs, the fatty growths can occur anywhere on the body.[13][14]

[15][16][17][18][19][4]

Lipedema Lipo-lymphedema Lymphedema Obesity Venous insufficiency/venous stasis
Symptoms Fat deposits / swelling in legs and arms not in hands or feet; hands and feet may be affected as the disease progresses. Fat deposits / swelling widespread in legs/arms/torso Fat deposits / swelling in one limb including hands and feet Fat deposits

widespread

Swelling near ankles; brownish discoloration of lower legs (hemosiderin deposits). Minimal swelling possible.
Male/female F F F/M F/M F/M
Onset Around hormonal shifts (puberty, pregnancy, menopause) Around hormonal shifts After surgery that affects lymphatic system, or at birth Any age Around onset of obesity, diabetes, pregnancy, hypertension
Diet Restricting calories ineffective Restricting calories ineffective Restricting calories ineffective Diets and weight loss strategies often effective No relation to caloric intake
Swelling Non-pitting edema Much edema; some pitting; some fibrosis Pitting edema No edema Often edema, but can also occur without edema in earlier stages
Stemmer sign Stemmer's Sign negative Stemmer's Sign positive Stemmer's Sign positive Stemmer's Sign negative Stemmer's sign may or may not be present in lymphedema/lipolymphedema
Pain Pain in affected areas likely Pain in affected areas No pain initially No pain Pain is likely
Frequency Best estimate is 11% adult women (study done in Germany) Unknown; best estimate is a few percent of adult women Low ≥30% of US adults >30% of US adults
Cellulitis No history of cellulitis Likely history of cellulitis Possible history of cellulitis Often itching +/- discoloration mistaken for cellulitis
Family history Family history likely Family history of lipedema likely Family history not likely unless primary lymphedema Family history likely Very likely family history

Treatment

A number of treatments may help including physiotherapy and exercise.[20] Compression stockings may help with pain and the ability to walk.[3] While manual lymphatic drainage (MLD) has been suggested, its benefits are unclear as of 2019.[2]

Surgery

The use of surgical techniques is not universal but research has shown positive results in both short-term and long-term studies.[21][22] regarding lymph-sparing liposuction and lipectomy.[23]

The studies of highest quality involve tumescent local anesthesia (TLA), often referred to as simply tumescent liposuction. This can be accomplished via both Suction-Assisted Liposuction (SAL) and Power-Assisted (vibrating) liposuction.[17][24] The treatment of lipedema with tumescent liposuction may require multiple procedures. While many health insurance carriers in the United States do not reimburse for liposuction for lipedema, in 2020 several carriers regard the procedure as reconstructive and medically necessary and do reimburse.[25] Water assisted liposuction (WAL) is technically not considered to be tumescent but achieves the same goal as the anesthetic solution is injected as part of the procedure rather than before-hand. It is usually performed under general anesthesia and is also considered to be lymph-sparing and protective of other tissues such blood vessels. [26]

Prognosis

There is no cure. Complications include a malformed appearance, reduced functionality (mobility and gait), poor quality of life (QOL), depression, anxiety, and pain.[4]

Epidemiology

Lipedema affects about 11% of the female population, although rates from 6-39% have also been reported.[27][28]

History

Lipedema was first identified in the United States, at the Mayo Clinic in 1940.[29][30] Most attribute the original identification of lipedema to EA Hines and LE Wold (1951).[29] In spite of that lipedema is barely known in the United States to physicians or to the patients who have the disease. Lipedema often is confused with obesity or lymphedema, and a significant number of patients currently diagnosed as obese are believed to have lipedema, either instead of or in addition to obesity.[4]

See also

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 "Lipedema". rarediseases.info.nih.gov. Archived from the original on 18 March 2021. Retrieved 30 December 2016.
  2. ↑ 2.0 2.1 2.2 Wollina, U (March 2019). "Lipedema-An update". Dermatologic therapy. 32 (2): e12805. doi:10.1111/dth.12805. PMID 30565362.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 "Lipoedema". nhs.uk. 2 October 2020. Archived from the original on 11 April 2021. Retrieved 1 April 2021.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Herbst, Karen L (2012). "Rare adipose disorders (RADs) masquerading as obesity". Acta Pharmacologica Sinica. 33 (2): 155–72. doi:10.1038/aps.2011.153. PMC 4010336. PMID 22301856.
  5. ↑ 5.0 5.1 5.2 Buck DW, 2nd; Herbst, KL (September 2016). "Lipedema: A Relatively Common Disease with Extremely Common Misconceptions". Plastic and reconstructive surgery. Global open. 4 (9): e1043. doi:10.1097/GOX.0000000000001043. PMID 27757353.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  6. ↑ "Lipedema | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Archived from the original on 30 December 2016. Retrieved 13 July 2021.
  7. ↑ Herbst, K. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin 33, 155–172 (2012). https://doi.org/10.1038/aps.2011.153 Archived 2021-08-28 at the Wayback Machine
  8. ↑ Herbst, K. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin 33, 155–172 (2012). https://doi.org/10.1038/aps.2011.153 Archived 2021-08-28 at the Wayback Machine
  9. ↑ Leopoldo Cobos, MD, Karen Herbst, PhD, MD, Christopher Ussery, MS, CSCS, MON-116 Liposuction for Lipedema (Persistent Fat) in the US Improves Quality of Life, Journal of the Endocrine Society, Volume 3, Issue Supplement_1, April-May 2019, MON–116
  10. ↑ Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012;166(1):161‐168. doi:10.1111/j.1365-2133.2011.10566.x
  11. ↑ Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L (2019). "Lipedema: A Call to Action!". Obesity (Silver Spring). 27 (10): 1567–1576. doi:10.1002/oby.22597. PMC 6790573. PMID 31544340. Archived from the original on 2023-04-13. Retrieved 2021-07-02.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ Leopoldo Cobos, MD, Karen Herbst, PhD, MD, Christopher Ussery, MS, CSCS, MON-116 Liposuction for Lipedema (Persistent Fat) in the US Improves Quality of Life, Journal of the Endocrine Society, Volume 3, Issue Supplement_1, April-May 2019, MON–116
  13. ↑ Beltran K, Herbst KL. Differentiating lipedema and Dercum's disease. Int J Obes (Lond). 2017;41(2):240‐245. doi:10.1038/ijo.2016.205
  14. ↑ "Archive copy". Archived from the original on 2017-10-11. Retrieved 2021-07-02.{{cite web}}: CS1 maint: archived copy as title (link)[full citation needed]
  15. ↑ Fat Disorders Research Society Lipedema Description Archived 2015-07-31 at the Wayback Machine
  16. ↑ Todd, Marie (2010). "Lipoedema: Presentation and management". British Journal of Community Nursing. 15 (4): S10–6. doi:10.12968/bjcn.2010.15.Sup3.47363. PMID 20559170. Archived from the original on 2021-08-28. Retrieved 2021-07-02.
  17. ↑ 17.0 17.1 Fife, Caroline E.; Maus, Erik A.; Carter, Marissa J. (2010). "Lipedema". Advances in Skin & Wound Care. 23 (2): 81–92. doi:10.1097/01.ASW.0000363503.92360.91. PMID 20087075. Archived from the original on 2021-08-28. Retrieved 2021-07-02.
  18. ↑ Földi, Michael; Földi, Ethel, eds. (2006). "Lipedema". Földi's Textbook of Lymphology. Munich: Elsevier. pp. 417–27. ISBN 978-0-7234-3446-7.
  19. ↑ Trayes, K. P.; Studdiford, J. S.; Pickle, S; Tully, A. S. (2013). "Edema: Diagnosis and management". American Family Physician. 88 (2): 102–10. PMID 23939641.
  20. ↑ Fetzer A, Wise C. Living with lipoedema: reviewing different self-management techniques. Br J Community Nurs. 2015;Suppl Chronic:S14‐S19. doi:10.12968/bjcn.2015.20.Sup10.S14
  21. ↑ Dadras, Mehran; Mallinger, Peter Joachim; Corterier, Cord Christian; Theodosiadi, Sotiria; Ghods, Mojtaba (2017). "Liposuction in the Treatment of Lipedema: A Longitudinal Study". Archives of Plastic Surgery. 44 (4): 324–331. doi:10.5999/aps.2017.44.4.324. PMC 5533060. PMID 28728329.
  22. ↑ Baumgartner, A.; Hueppe, M.; Schmeller, W. (May 2016). "Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years". British Journal of Dermatology. 174 (5): 1061–1067. doi:10.1111/bjd.14289. PMID 26574236.
  23. ↑ Sandhofer M, Hanke CW, Habbema L, et al. Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference. Dermatol Surg. 2020;46(2):220‐228. doi:10.1097/DSS.0000000000002019
  24. ↑ Langendoen, S.I.; Habbema, L.; Nijsten, T.E.C.; Neumann, H.A.M. (2009). "Lipoedema: From clinical presentation to therapy. A review of the literature". British Journal of Dermatology. 161 (5): 980–6. doi:10.1111/j.1365-2133.2009.09413.x. PMID 19785610. Archived from the original on 2021-08-28. Retrieved 2021-07-02.
  25. ↑ "Cosmetic and Reconstructive Services of the Trunk and Groin". November 12, 2019. Archived from the original on October 28, 2020. Retrieved July 2, 2021.
  26. ↑ Forner-Cordero, I.; Szolnoky, G.; Forner-Cordero, A.; Kemény, L. (2012). "Lipedema: An overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review". Clinical Obesity. 2 (3–4): 86–95. doi:10.1111/j.1758-8111.2012.00045.x. PMID 25586162. Archived from the original on 2021-08-28. Retrieved 2021-07-02.
  27. ↑ Foldi, E. and Foldi, M. (2006) Lipedema. In Foldi's Textbook of Lymphology (Foldi, M., and Foldi, E., eds) pp. 417-427, Elsevier GmbH, Munich, Germany
  28. ↑ Reich‐Schupke, Stefanie; Schmeller, Wilfried; Brauer, Wolfgang Justus; Cornely, Manuel E.; Faerber, Gabriele; Ludwig, Malte; Lulay, Gerd; Miller, Anya; Rapprich, Stefan; Richter, Dirk Frank; Schacht, Vivien; Schrader, Klaus; Stücker, Markus; Ure, Christian (July 2017). "S1 guidelines: Lipedema". JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 15 (7): 758–767. doi:10.1111/ddg.13036.
  29. ↑ 29.0 29.1 Wold, LE; Hines, EA; Allen, EV (1 May 1951). "Lipedema of the legs: a syndrome characterized by fat legs and edema". Annals of Internal Medicine. 34 (5): 1243–50. doi:10.7326/0003-4819-34-5-1243. PMID 14830102.
  30. ↑ HINES, EA (2 January 1952). "Lipedema and physiologic edema". Proceedings of the Staff Meetings. Mayo Clinic. 27 (1): 7–9. PMID 14900206.

External links

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External resources

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