From the Guidelines
Lipedema is indeed a real disease, characterized by abnormal fat deposition primarily in the legs, thighs, and sometimes arms, affecting almost exclusively women. It is a chronic disorder that is distinct from obesity or lymphedema, as the fat distribution is symmetrical and disproportionate to the rest of the body, and the feet are typically spared 1. The condition progresses through stages, from mild skin texture changes to more severe manifestations including nodules, pain, and mobility issues.
Key Characteristics of Lipedema
- Abnormal fat deposition in the legs, thighs, and arms
- Symmetrical fat distribution
- Disproportionate to the rest of the body
- Feet are typically spared
- Affects almost exclusively women
Treatment Options
- Conservative measures: compression garments, manual lymphatic drainage, and specialized exercise programs
- Surgical procedure: liposuction to remove abnormal fat deposits in advanced cases According to the study published in Circulation 1, lipedema is listed as a cause of lower extremity edema, with adipose tissue accumulation being the underlying mechanism. While the study primarily focuses on nonthrombotic iliac vein lesions, it acknowledges lipedema as a distinct condition that can present with edema.
Importance of Proper Diagnosis
Lipedema is believed to have genetic components and hormonal influences, often appearing or worsening during puberty, pregnancy, or menopause 1. Despite being recognized by the World Health Organization, lipedema remains underdiagnosed and often mistaken for simple obesity, leading to delays in proper treatment and management.
Clinical Considerations
It is essential to evaluate and exclude other potential causes of edema, such as medications, lymphedema, or other systemic causes, before intervening on a patient with lipedema 1. Significant edema extending to the thigh that affects quality of life may warrant intervention, whereas limited ankle edema may not warrant intervention, and other potential etiologies should be investigated.
From the Research
Definition and Prevalence of Lipedema
- Lipedema is a loose connective tissue disease that predominantly affects women, characterized by increased nodular and fibrotic adipose tissue on the buttocks, hips, and limbs 2.
- It is estimated to affect nearly 11% of adult women worldwide, with a prevalence of around 10% in the overall female population 3, 4.
- Lipedema is often misdiagnosed as obesity or lymphedema, which can lead to unnecessary medical interventions and delayed treatment 5, 3.
Clinical Features and Diagnosis
- Lipedema is characterized by disproportionate adipocyte hypertrophy of the lower extremities, significant tenderness to palpation, and a failure to respond to extreme weight loss modalities 3.
- The diagnosis of lipedema is largely clinical and based on criteria initially established in 1951, with no specific biomarker available yet 3, 4.
- Ancillary tests are used only to rule out competing diagnoses, and the diagnosis remains a challenge due to the heterogeneous presentation of the condition 4.
Treatment Options
- Treatment of lipedema includes complex decongestive therapy, liposuction, and laser-assisted lipolysis, with the goal of reducing symptoms and improving quality of life 5, 3, 4.
- Complete decongestive therapy (CDT) has been shown to provide significant improvements in reducing limb volumes, pain, and physical function when administered in addition to exercises 6.
- Liposuction has been found to relieve symptoms to a significant extent, with only rare complications, but its cost is not yet regularly covered by statutory health insurance carriers in some countries 4.
Research and Awareness
- There is a need for further research to elucidate the pathophysiology of lipedema and develop a specific biomarker for the condition 4.
- Generating awareness and conducting additional research are crucial to improve the understanding and management of lipedema, and to provide affected individuals with the care they need and deserve 3, 2.