Abstract
Lipedema is a frequently unrecognized and misdiagnosed disorder of the fatty tissue of extremities and hips, which affects almost purely women. The beginning of the disease usually occurs with hormonal changes, such as puberty, pregnancy, or menopause. Women suffer from pain, easy bruising, and disfigurement, which may lead to early immobility and social stress. Accurate diagnosis and treatment are essential. The differentiation between obesity and lipedema is difficult, as these two different entities often occur together. Other differential diagnoses are lymphedema, benign lipohypertrophy, and Dercum’s disease. A therapy targeting the underlying cause of lipedema is not available because the exact etiology of the disorder is not clarified yet. Decongestive physical therapy is the basic conservative treatment, which is usually necessary lifelong. However, liposuction has led to a paradigm shift in the treatment of lipedema. The purposes of this article are to describe the symptoms and treatment options of the still fairly unknown disease Lipedema and to show the distinctions to its differential diagnoses.
Highlights
Lipedema is a painful disease of the subcutaneous tissue, which was first named in 1940 by Allen and Hines
Lipedema is possibly a common but underdiagnosed disorder, which is almost exclusively found in females, but, as there is no standardized diagnostic test, the exact prevalence is unknown
According to German studies, 8%-18% of patients referred to a lymphedema clinic suffer from lipedema[2,3,4]
Summary
Lipedema is a painful disease of the subcutaneous tissue, which was first named in 1940 by Allen and Hines. Possibly chronically progressive disorder of adipose tissue that is characterized by symmetrical swelling of the lower and/or upper limbs. The severity of lipedema can be classified into four clinical stages according to skin conditions and the sizes of the palpable and visible fat nodules[15,16] [Figure 3]: Stage 1: Flat skin with thickened subcutaneous tissue; Stage 2: Increasing subcutaneous fat and walnut to apple-like indurations in the skin akin to a mattress; Stage 3: Larger indurations and deforming skin-fat lobes, especially in the thighs and knee areas; Stage 4: Development of additional lymphedema (lipolymphedema).
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