From the Guidelines
The workup for lipedema begins with a thorough clinical evaluation, as there are no specific laboratory or imaging tests that definitively diagnose this condition. The diagnosis is primarily clinical, based on patient history and physical examination. Key diagnostic features include disproportionate fat accumulation in the lower extremities (and sometimes arms) with sparing of the hands and feet, minimal response to weight loss efforts, tenderness to palpation, easy bruising, and bilateral symmetrical presentation. A comprehensive medical history should assess for family history of similar symptoms, onset around puberty or hormonal changes, and progression over time. Physical examination should include assessment of fat distribution patterns, skin texture, presence of Stemmer's sign (negative in lipedema, positive in lymphedema), and evaluation for pain or tenderness.
Important Considerations
- Bioimpedance analysis may help differentiate lipedema from lymphedema by measuring tissue fluid content 1.
- Ultrasound or MRI imaging, while not required, can sometimes help visualize the characteristic fat deposition patterns and rule out other conditions.
- Psychological assessment is also important as lipedema often impacts quality of life and mental health.
- The workup should exclude other conditions with similar presentations, such as lymphedema, obesity, chronic venous insufficiency, and other causes of lower extremity swelling, as outlined in a recent consensus statement 1.
Differential Diagnosis
- Lymphedema: characterized by excessive accumulation of lymphatic fluid, often presenting with asymmetrical swelling and a positive Stemmer's sign.
- Chronic venous insufficiency: presents with increased venous hypertension and capillary permeability, often causing lower extremity swelling.
- Other causes of lower extremity edema, such as cardiac, hepatic, renal, or thyroid disorders, should also be considered and excluded based on clinical evaluation and laboratory tests as necessary.
Given the complexity of diagnosing lipedema and the potential for similar presentations with other conditions, a thorough and comprehensive clinical evaluation is essential to accurately diagnose and manage lipedema, prioritizing the patient's quality of life and minimizing morbidity and mortality risks.
From the Research
Diagnosis of Lipedema
- Lipedema is often unrecognized or misdiagnosed, and its cause is still unknown 2
- The diagnosis of lipedema is currently made on clinical grounds alone, with no specific biomarker available 2
- Ancillary tests are used only to rule out competing diagnoses, such as obesity or lymphedema 2
Clinical Evaluation
- The clinical evaluation of lipedema involves assessing the patient's medical history, physical examination, and laboratory tests to rule out other conditions 3
- The patient's symptoms, such as pain, easy bruising, and aesthetic deformity, are also evaluated 3
Treatment Options
- Complex decongestive therapy (CDT) is a common treatment for lipedema, which involves a combination of manual lymphatic drainage, compression bandaging, and exercise 4, 5
- Intermittent pneumatic compression therapy (IPCT) may also be used in conjunction with CDT or exercise alone 4, 5
- Liposuction has been found to relieve symptoms in some patients, but its use is not yet widely accepted and requires further research 2