Lipedema is a condition often misdiagnosed as obesity. While obesity may accompany this disease as it progresses, they are different conditions. Lipedema is “a chronically progressive, [bilateral] symmetrical accumulation of fat in the subcutaneous tissue with orthostatic edema occurring almost exclusively in women.” It is unclear if the fat cells multiply at an abnormal rate, are abnormally large or if the fat accumulation is a combination of these. Additionally, capillary permeability is increased causing fluid & protein to accumulate in the interstitium which, in turn, causes edema. The added swelling & protein causes hypersensitivity to pressure & touch, & the increased capillary fragility causes bruising with mild trauma. Besides edema, hypersensitivity & bruising, people with this condition may struggle with depression, embarrassment or shame. This may especially be the case when they have been told they are just “fat” & need to lose weight. However, this condition cannot be “starved” away. The cause of lipedema is thought to be attributed to a hormonal disturbance or, more commonly, a genetic predisposition (several women in a family often have lipedema).
Frequently, lipedema starts at the hips & ends at the ankles though it can begin in the lower legs & progress upwards. While the upper body can be involved, it is usually the legs. In cases involving the legs, the feet are not involved & (if the upper body isn’t involved) the upper body is disproportionately smaller. Men can have lipedema (when there is a hormonal disturbance such as testosterone deficiency)2 but it is more common in women & typically presents around the time a woman experiences a hormone change (puberty, menopause or pregnancy). There are two forms: Column-shaped (a truncated appearance) & lobar.
Diagnosis of lipedema is done through medical history & clinical examination, differentiating it from other conditions such as lymphedema or lipo-lymphedema (lipedema with lymphedema). Additionally, an indirect lymphography may be done during which a contrast dye is injected into the skin & moves along the fat cells “from the dermis into the edematously dilated system of prelymphatic channels located between the adipocytes.”3
Treatment includes: Prevention of lipo-lipedema6 (obesity & lipedema) by engaging a regiment of calorie-conscious, low-fat, low-carb diet & exercise; liposuction (which must be cautiously considered & only performed by a specialist knowledgeable about lymphedema & the lymphatic system); Complete Decongestive Therapy (CDT). Combination of the latter two treatments has proven to be very effective. However, these treatments do not change the increased capillary permeability which promotes the edema, so long-term treatment [CDT & compression garments] is needed.5 If the lipedema is in its early stages (edema reduces with limb elevation), compression garments alone can prevent the edema.
In CDT, the decongestion phase (Phase I) should be done without bandages the first few days because of the hypersensitivity of the tissue. After this time, bandages can be slowly & cautiously applied. MLD should be performed daily. At the conclusion of treatment, a person must wear long-term compression garments. Compression will compress the fat cells, causing the edema to move out of the adipose tissue & into the connective tissue, giving initial lymph vessels access to drain the fluid.3 In the maintenance phase (Phase II), MLD should be continued 1-2x/week. It is important to note that gastric bypass & gastric lap band procedures are not appropriate. Diuretics (as treatment for lipedema) are also not indicated.4
References
1Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 418. Germany: Urban & Fisher. Foldi, M, Foldi, E. (2006).
2Weissleder, H. Schuchhardt, C. (2008). Lymphedema Diagnosis and Therapy (4th ed.), p.295. Germany: VVA GmbH/Wesel Kommunikation.
3Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 423. Germany: Urban & Fisher. Foldi, M, Foldi, E. (2006).
4Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 425. Germany: Urban & Fisher. Foldi, M, Foldi, E. (2006).
5Weissleder, H. Schuchhardt, C. (2008). Lymphedema Diagnosis and Therapy (4th ed.), p.312. Germany: VVA GmbH/Wesel Kommunikation.
6Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 425. Germany: Urban & Fisher. Foldi, M, Foldi, E. (2006).
