Lipedema

Signs and symptoms of lipedema vary from person to person and usually appear around puberty, pregnancy, or menopause. Symptoms typically include enlarged legs extending from the buttocks to the ankles. This enlargement can be painful. The size of the legs are typically out of proportion to the upper body (despite the individual’s BMI). The feet are much less involved or spared entirely.^[3][4] In early stages of lipedema, the upper body may remain slender. As the disorder progresses, the chest, torso, abdomen, and upper extremities may become involved.^[4]

The skin overlying affected areas usually appears normal, although it may lose elasticity. People with lipedema tend to bruise easily, possibly due to increased fragility of small blood vessel within the fat tissue.^[3][4][2]

The cause of lipedema is unknown. Hormones appear to play a role, especially considering that the condition occurs almost entirely in females and often develops after puberty or other periods of hormone change (e.g., pregnancy, menopause). Although people who are obese may be overrepresented among those with lipedema, persons of normal weight are also commonly affected. As a result, obesity alone is unlikely to be a major determinant of this syndrome. Many people with lipedema have a family history of similarly enlarged legs. At this time the role of genetics in the causation of lipedema is unknown.^[1][4]

There is not a universally recognized process to evaluate and diagnose lipedema. Some researchers suggest that the best way to diagnose lipedema is by completing a physical examination with a trained medical professional familiar with the disorder. At some stages of the disease, it may be possible to see evidence of lipedema via imaging studies such as ultrasound, MRI, lymphangiogram, and/or lymphoscintigraphy. Test results may appear ‘normal’  in the early stages of lipedema.^[2][4][5]

It is important to differentiate lipedema from other similar disorder including but not limited to: obesity, lipohypertrophy (similar presentation without pain and edema), and lymphedema. In cases of more advanced edema, other causes of classical edema of the lower legs (chronic venous insufficiency, idiopathic edema, edema due to internal disease, and postural/orthostatic edema) should be considered.^[2][4][5]

Previous diagnostic guidelines published by Wold et al in 1951 proposed a series of criteria to diagnose lipedema, which include the following: occurrence almost exclusively in women; bilateral and symmetrical presentation with minimal involvement of the feet; minimal pitting edema, pain, tenderness, and easy bruising; and persistent swelling of lower extremities despite elevation or weight loss.^[6] Recently, the Dutch Society of Dermatology and Venereology organized a task force to create guidelines on lipedema including diagnostic criteria. They proposed a diagnosis of lipedema with the criteria as defined by Wold et al in addition to symptoms of the upper leg(s) and arm(s) such as a circularly thickened layer of fat affecting the skin.^[5]

There is no one treatment for lipedema; however various strategies have been used to manage symptoms. One such method is complex decongestive physiotherapy (CDT). CDT is an intensive program that combines different treatment approaches such as bandaging, compression garments, manual lymphatic drainage (massage technique that aims to encourage drainage of lymph fluid), exercise, and self care. In a study of 38 women with lipedema, CDT was found to successfully reduce the rate of bruise formation.^[1][5][7]

Surgery is the only available technique to correct abnormal adipose tissue. There are two surgical options: liposuction and excision of fatty tissues (lipectomy). Invasive treatments are controversial as they may lead to damage of the lymphatic system.^[1][2][5]