What is Lipoedema?
Lipoedema is a chronic condition which almost exclusively effects women and is often misdiagnosed as obesity. It can make areas of the body look out of proportion, but it different to normal weight gain. It is a as connective adipose (fat) tissue disorder which is characterised by symmetrical distribution of abnormal fat in the hips, buttocks, legs, and sometimes the arms. It doesn’t affect your hands or feet. Lipoedema is a painful condition that can affect patient mobility.
There are several stages of lipoedema. In the earliest stage the area that stores fat starts to enlarge. The skin may start to becomes uneven and may look bumpy and dimpled. The affected areas start to enlarge and change shape. In its most advanced stage, fluid collects in the area as well as fat. This stage is called lipo-lymphoedema.
Lipoedema can sometimes be confused with a condition called lymphoedema. Lymphoedema is a build-up of fluid in your tissues and usually only affects a limb on one side of your body.
What causes lipoedema?
Clinicians do not know the exact cause of lipoedema. It is a genetic condition that often runs in families, and you may inherit it. It may also have a connection to hormones as it can present or worsen during puberty, pregnancy and menopause. The condition occurs almost exclusively in women and is rarely found in men. The exact number of people living with the condition is unknown due to misdiagnosis and underreporting, but it may affect as many as 10-11% of the population.
How is Lipoedema diagnosed?
Obtaining a Lipoedema diagnosis can be challenging for patients as it can be misdiagnosed and underrecognized. It can often be mistaken for weight gain. Diet and exercise are important for overall health, it does not reduce the fat build up seen in lipoedema patients. Lipoedema presents in puberty, but many people do not get diagnosed until later in life, but early diagnosis is crucial for symptom management in patients.
There is no specific diagnostic test for lipoedema. Physical examination of fat deposition, family history, pain, bruising and tenderness in the effected areas should be discussed. As lipoedema does not affect feet or hands the lack of swelling and ‘braceleting effect’ in these areas is usually indicative of lipoedema.
Lipoedema may often be mistaken for lymphoedema. The Stemmer’s sign can help differentiate lipoedema from lymphoedema. This is done by pinching the skin on the toes of the patient. In lipoedema the Stemmer’s sign is negative. The fold of skin can be pinched and lifted up at the base of the second toe or at the base of the middle finger. In lymphoedema the Stemmer’s sign is positive, which is indicated by the inability to lift the fold of skin . Some patients may develop lymphoedema secondary to lipoedema.
What are the symptoms of Lipoedema?
The main symptom of lipoedema is the development of abnormal body fat. This is most often in the lower half of the body in the hips and thighs. The arms and torso can also be affected but the hands and the feet usually remain unchanged which is usually indicative that it is lipoedema. Lipoedema usually present symmetrically and there is a significant disproportion in the hip to wait ratio.2,3
Symptoms include:
- Painful joints and reduced mobility, especially after standing and exercise.
- Pain and tenderness in areas of fat deposition.
- Easy or excessive bruising.
- Swelling in hot weather or during flying or periods of inactivity.
- Fatigue.
- Anxiety, phycological distress and depression.
- Flat feet.
- Skin may appear dimpled and cool to the touch.
- Weight-loss and dieting may have little or no effect on fat reduction.
- Varicose Veins
What are the treatments for lipoedema?
At present there is no cure for lipoedema, but there are treatments at can help manage the symptoms:
Compression Therapy
- Compression therapy can help support the affected areas of the body by using pressure to manage the pain and discomfort. It can also help manage the shape of the affected limb and in some cases may move lymph from the area to reduce swelling and prevent symptoms getting worse. There are different types of compression therapy such as sleeves, stockings and bandages. It is important these fit well and in some cases, they will be made to measure for the patient.
- It is very important that you are measured and that your compression garments fit well. Sometimes, they may need to be specially made for you.
Manual lymphatic drainage (MLD)
- MLD is a massage technique that is used to reduce swelling caused by fluid that may build up in patients with lipoedema. This is often used alongside compression therapy.
Skin care:
- Skin may become dry, and folds may develop. The affected limb(s) should be cleaned and dried gently, and an emollient applied daily if necessary. Protecting the skin from injury is important to reduce the risk of cellulitis.
Lifestyle management
- Dieting does not have an impact on abnormal fat deposits, with weight loss usually occurring elsewhere on the body first. However, it can still be beneficial for overweight or obese people to lose weight since it reduces pressure on the joints and tissues as well as decreases the risk of conditions such as diabetes. Losing weight can also improve mobility. Similarly, eating well to maintain a normal weight has many benefits for health and wellness in people with lipoedema. Skin care and protection
Liposuction
- Liposuction is sometimes performed for lipoedema. It can help to reduce pain and help improve mobility, but it is not a cure. It is important to note that that fat and the symptoms may return.
For all treatments, please seek advice from a medical professional.
Where can I find more information?
More Information on the condition can be found at:
- British Lymphology Society – www.lymphoedema.org/bls
- Lipoedema UK – www.lipoedema.co.uk
- Lipoedema NHS Choices – www.nhs.uk/conditions/lipoedema
- Legs Matter- www.legsmatter.org
References:
- 1. https://www.nhs.uk/conditions/lipoedema/
- 2. Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int. 2020 Jun 1;117(22-23):396-403. doi: 10.3238/arztebl.2020.0396. PMID: 32762835; PMCID: PMC7465366.
- 3. Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016 Aug 11;8:389-95. doi: 10.2147/IJWH.S106227. PMID: 27570465; PMCID: PMC4986968.
- 4. https://www.lipedema.org/treating-lipedema
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