From the Guidelines
Lipedema is a chronic disorder characterized by abnormal fat accumulation primarily in the legs and sometimes arms, affecting almost exclusively women, and is distinct from other causes of lower extremity edema such as lymphedema, venous insufficiency, or nonthrombotic iliac vein lesions (NIVL) 1. The key characteristics of lipedema include the symmetrical buildup of painful subcutaneous fat that feels nodular and can be tender to touch, primarily in the legs and sometimes arms, with the condition typically sparing the hands, feet, and trunk. Unlike regular obesity, lipedema fat doesn't respond well to diet and exercise. Some of the key features of lipedema, as distinguished from other conditions like NIVL, include:
- Abnormal fat accumulation
- Primarily affects the legs and sometimes arms
- Typically spares the hands, feet, and trunk
- Does not respond well to diet and exercise
- Can be painful and tender to touch
- Often worsens at hormonal milestones like puberty, pregnancy, or menopause
- Causes physical discomfort, mobility issues, and psychological distress due to body image concerns Management of lipedema includes:
- Compression garments to reduce swelling
- Manual lymphatic drainage massage
- Proper skin care
- Maintaining overall health through gentle exercise like swimming or walking
- In advanced cases, specialized liposuction may be considered to remove the abnormal fat deposits It is essential to differentiate lipedema from other conditions that cause lower extremity edema, such as NIVL, lymphedema, or chronic venous insufficiency, to provide appropriate treatment and management, as highlighted in the consensus statement on the management of nonthrombotic iliac vein lesions 1.
From the Research
Definition and Characteristics of Lipedema
- Lipedema is a chronic progressive disease characterized by the abnormal accumulation of fat in the subcutaneous region, leading to disproportionate, painful limbs 2, 3.
- It almost exclusively affects women, resulting in considerable disability, daily functioning impairment, and psychosocial distress 3.
- The condition is often underdiagnosed and misdiagnosed with other similarly presenting diseases, such as lymphedema or obesity 3, 4.
Symptoms and Diagnosis
- Common symptoms of lipedema include pain, tenderness, easy bruising, and swelling in the affected areas, typically the lower limbs 2, 5, 4.
- Diagnosis of lipedema is crucial for initial treatment and improvement of the patient's quality of life, and can be made through a combination of physical examination, medical history, and imaging studies 6.
Treatment Options
- Various treatment options are available for lipedema, including non-surgical therapies, such as lymphatic drainage and compression stockings, as well as surgical techniques, like liposuction and excisional lipectomy 2, 5, 3.
- Nutritional intervention may also be a useful adjunct to traditional treatment, improving quality of life and reducing pain, although further research is needed to fully understand its effects 6.
Pathophysiology and Genetics
- The exact pathophysiology of lipedema is not yet fully understood, but it is thought to involve a combination of hormonal, microvascular, and lymphatic disorders, as well as polygenic susceptibility 3, 4.
- Lipedema is proposed to be a genetic condition, with either X-linked dominant inheritance or autosomal dominant inheritance with sex limitation, and is likely to be estrogen-requiring 4.