Lipedema

Depression and anxiety are very common for a variety of reasons, particularly the fact that diagnosis usually takes a long time and patients have received much advice on diet and exercise in the meantime, neither of which are effective treatments for lipedema although they may help associated conditions.Herbst, K. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin 33, 155–172 (2012). https://doi.org/10.1038/aps.2011.153 Joint pain, arthritis, dry skin, fungal infections, cellulitis and slow wound healing are also associated with lipedema.

The cause of lipedema is still unknown. There are various hypotheses about its pathophysiology, including altered adipogenesis, microangiopathy, and damage to the lymphatic system disturbing its microcirculation.{{citation

| title=Lipedema—Pathogenesis, Diagnosis, and Treatment Options

| date=June 1, 2020

| pmc=7465366

| last1=Kruppa

| first1=P.

| last2=Georgiou

| first2=I.

| last3=Biermann

| first3=N.

| last4=Prantl

| first4=L.

| last5=Klein-Weigel

| first5=P.

| last6=Ghods

| first6=M.

| journal=Deutsches Ärzteblatt International

| volume=117

| issue=22–23

| pages=396–403

| doi=10.3238/arztebl.2020.0396

| pmid=32762835

}} Lipedema has been described in familial clusters, suggesting a genetic component.

{{citation

| url=https://www.medicalnewstoday.com/articles/lipedema-stages

| title=Lipedema: Diagnosis, causes, and types

| date=March 15, 2022

| access-date=April 13, 2024

}} It often appears around times of hormonal change such as puberty, pregnancy, and menopause, suggesting a potential hormonal component.

{{citation

| url=https://www.jobst-usa.com/patients/lymphcare/what-is-lipedema.html

| title=What Is Lipedema?

| access-date=April 13, 2024

}}

Having obesity doesn’t cause lipedema, but more than half of people with this condition have a BMI higher than 35.

{{citation

| url=https://my.clevelandclinic.org/health/diseases/17175-lipedema

| title=Lipedema

| date=June 1, 2023

| access-date=April 13, 2024

}}

Fat Disorders Research Society [http://www.fatdisorders.org/fat-disorders/lipedema-lipoedema-description Lipedema Description] {{Webarchive|url=https://web.archive.org/web/20150731052510/http://fatdisorders.org/fat-disorders/lipedema-lipoedema-description |date=2015-07-31 }}{{cite journal |doi=10.12968/bjcn.2010.15.Sup3.47363 |pmid=20559170 |title=Lipoedema: Presentation and management |journal=British Journal of Community Nursing |volume=15 |issue=4 |pages=S10–6 |year=2010 |last1=Todd |first1=Marie |s2cid=22897427 }}{{cite book |editor1-first=Michael |editor1-last=Földi |editor2-first=Ethel |editor2-last=Földi |year=2006 |chapter=Lipedema |pages=417–27 |title=Földi's Textbook of Lymphology |location=Munich |publisher=Elsevier |isbn=978-0-7234-3446-7 }}{{cite journal |pmid=23939641 |year=2013 |last1=Trayes |first1=K. P. |title=Edema: Diagnosis and management |journal=American Family Physician |volume=88 |issue=2 |pages=102–10 |last2=Studdiford |first2=J. S. |last3=Pickle |first3=S |last4=Tully |first4=A. S. }}{{cite journal |last1=Herbst |first1=Karen L |author-link=Karen Herbst |year=2012 |title=Rare adipose disorders (RADs) masquerading as obesity |journal=Acta Pharmacologica Sinica |volume=33 |issue=2 |pages=155–72 |doi=10.1038/aps.2011.153 |pmc=4010336 |pmid=22301856}}

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.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–116Schmeller 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

Lipedema is often underdiagnosed due to the difficulty in differentiating it from lymphedema, obesity, or other edemas.{{cite journal| author=Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L| title=Lipedema: A Call to Action! | journal=Obesity (Silver Spring) | year= 2019 | volume= 27 | issue= 10 | pages= 1567–1576 | pmid=31544340 | doi=10.1002/oby.22597 | pmc=6790573 }}

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.

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.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{{Cite web |url=http://fatdisorders.org/fat-disorders/diagram |title=FDRS Diagram |access-date=2015-07-09 |archive-date=2017-10-11 |archive-url=https://web.archive.org/web/20171011231752/http://fatdisorders.org/fat-disorders/diagram |url-status=dead }}{{full citation needed|date=February 2017}}

Several treatments may be useful including physiotherapy and light exercise which does not put undue stress on the lymphatic system.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 The two most common conservative treatments are manual lymphatic drainage (MLD) where a therapist gently opens lymphatic channels and moves the lymphatic fluid using hands-on techniques, and compression garments that keep the fluid at bay and assist the sluggish lymphatic flow.{{Cite journal |last=Hardy |first=Denise |date=October 2016 |title=Best practice guidelines for the management of lipoedema |url=https://doi.org/10.12968/bjcn.2017.22.Sup10.S44 |journal=British Journal of Community Nursing |volume=22 |issue=Sup10 |pages=s44–s48 |doi=10.12968/bjcn.2017.22.Sup10.S44 |pmid=28961048 |via=CINAHL}}

The use of surgical techniques is not universal but research has shown positive results in both short-term and long-term studies{{cite journal |last1=Dadras |first1=Mehran |last2=Mallinger |first2=Peter Joachim |last3=Corterier |first3=Cord Christian |last4=Theodosiadi |first4=Sotiria |last5=Ghods |first5=Mojtaba |title=Liposuction in the Treatment of Lipedema: A Longitudinal Study |journal=Archives of Plastic Surgery |date=2017 |volume=44 |issue=4 |pages=324–331 |doi=10.5999/aps.2017.44.4.324 |pmid=28728329 |pmc=5533060 }}{{cite journal |last1=Baumgartner |first1=A. |last2=Hueppe |first2=M. |last3=Schmeller |first3=W. |title=Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years |journal=British Journal of Dermatology |date=May 2016 |volume=174 |issue=5 |pages=1061–1067 |doi=10.1111/bjd.14289 |pmid=26574236 |s2cid=54522402 }} regarding lymph-sparing liposuction and lipectomy.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

The studies of the 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.{{cite journal |doi=10.1097/01.ASW.0000363503.92360.91 |pmid=20087075 |title=Lipedema |journal=Advances in Skin & Wound Care |volume=23 |issue=2 |pages=81–92 |year=2010 |last1=Fife |first1=Caroline E. |last2=Maus |first2=Erik A. |last3=Carter |first3=Marissa J. |s2cid=14350132 }}{{cite journal |doi=10.1111/j.1365-2133.2009.09413.x |pmid=19785610 |title=Lipoedema: From clinical presentation to therapy. A review of the literature |journal=British Journal of Dermatology |volume=161 |issue=5 |pages=980–6 |year=2009 |last1=Langendoen |first1=S.I. |last2=Habbema |first2=L. |last3=Nijsten |first3=T.E.C. |last4=Neumann |first4=H.A.M. |s2cid=30001846 |doi-access=free }} 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 regarded the procedure as reconstructive and medically necessary and did reimburse.{{cite web |title=Cosmetic and Reconstructive Services of the Trunk and Groin |url=https://www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_a050277.html |date=November 12, 2019 }} 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. Developed by Doctor Ziah Taufig from Germany, it is usually performed under general anesthesia and is also considered to be lymph-sparing and protective of other tissues such as blood vessels.{{cite journal |doi=10.1111/j.1758-8111.2012.00045.x |pmid=25586162 |title=Lipedema: An overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review |journal=Clinical Obesity |volume=2 |issue=3–4 |pages=86–95 |year=2012 |last1=Forner-Cordero |first1=I. |last2=Szolnoky |first2=G. |last3=Forner-Cordero |first3=A. |last4=Kemény |first4=L. |s2cid=45550292 }}

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

According to an epidemiologic study by Földi E and Földi M, lipedema affects 11% of the female population, although rates from 6-39% have also been reported.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, GermanyReich-Schupke S, Schmeller W, Brauer WJ, et al. S1 guidelines: Lipedema. J Dtsch Dermatol Ges. 2017;15(7):758-767. doi: 710.1111/ddg.13036

Lipedema was first identified in the United States, at the Mayo Clinic, in 1940.{{cite journal |last1=Wold |first1=LE |last2=Hines |first2=EA |last3=Allen |first3=EV |title=Lipedema of the legs: a syndrome characterized by fat legs and edema |journal=Annals of Internal Medicine |date=1 May 1951 |volume=34 |issue=5 |pages=1243–50 |doi=10.7326/0003-4819-34-5-1243 |pmid=14830102 |s2cid=12401140 }}{{cite journal |last1=HINES |first1=EA |title=Lipedema and physiologic edema |journal=Proceedings of the Staff Meetings of the Mayo Clinic |date=2 January 1952 |volume=27 |issue=1 |pages=7–9 |pmid=14900206 }} Most attribute the original identification of lipedema to E. A. Hines and L. E. Wold (1951). Despite 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.

• Lymphedema
• Steatopygia
• Adiposis dolorosa
• Lipodystrophy

{{Medical resources

| ICD10 = {{ICD10|R60}}, {{ICD10|E88.2}}

| OMIM = 614103

| DiseasesDB = 7491

| MeshID = D065134

| Orphanet = 77243

}}

{{Medicine}}

Category:Diseases of veins, lymphatic vessels and lymph nodes

Category:Women's health