Lipedema, a frequently unrecognized problem

Fonder, Margaret A.; Loveless, James W.; Lazarus, Gerald S.

doi:10.1016/j.jaad.2006.09.023

Cited by 61 publications

(51 citation statements)

References 8 publications

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“…Typically, the disorder develops insidiously after puberty and progresses gradually. Moreover, patients with morbid obesity and longstanding lipoedema can develop a secondary mechanical insufficiency of the lymphatic system, producing a lipolymphoedema [72] due to associated difficulties with ambulation, which limits activation of the muscle pump in the lower extremities and subsequently leads to pitting oedema due to inactivity [73]. …”

Section: Differential Diagnosesmentioning

confidence: 99%

Review of Dercum’s disease and proposal of diagnostic criteria, diagnostic methods, classification and management

Hansson

Svensson

Brorson

2012

Orphanet J Rare Dis

105

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Definition and clinical picture: We propose the minimal definition of Dercum's disease to be generalised overweight or obesity in combination with painful adipose tissue. The associated symptoms in Dercum's disease include fatty deposits, easy bruisability, sleep disturbances, impaired memory, depression, difficulty concentrating, anxiety, rapid heartbeat, shortness of breath, diabetes, bloating, constipation, fatigue, weakness and joint aches. Classification:We suggest that Dercum's disease is classified into: I. Generalised diffuse form A form with diffusely widespread painful adipose tissue without clear lipomas, II. Generalised nodular form -a form with general pain in adipose tissue and intense pain in and around multiple lipomas, and III. Localised nodular form -a form with pain in and around multiple lipomas IV. Juxtaarticular form -a form with solitary deposits of excess fat for example at the medial aspect of the knee.Epidemiology: Dercum's disease most commonly appears between the ages of 35 and 50 years and is five to thirty times more common in women than in men. The prevalence of Dercum's disease has not yet been exactly established.Aetiology: Proposed, but unconfirmed aetiologies include: nervous system dysfunction, mechanical pressure on nerves, adipose tissue dysfunction and trauma. Diagnosis and diagnostic methods: Diagnosis is based on clinical criteria and should be made by systematic physical examination and thorough exclusion of differential diagnoses. Advisably, the diagnosis should be made by a physician with a broad experience of patients with painful conditions and knowledge of family medicine, internal medicine or pain management. The diagnosis should only be made when the differential diagnoses have been excluded. Differential diagnosis: Differential diagnoses include: fibromyalgia, lipoedema, panniculitis, endocrine disorders, primary psychiatric disorders, multiple symmetric lipomatosis, familial multiple lipomatosis, and adipose tissue tumours. Genetic counselling: The majority of the cases of Dercum's disease occur sporadically. A to G mutation at position A8344 of mitochondrial DNA cannot be detected in patients with Dercum's disease. HLA (human leukocyte antigen) typing has not revealed any correlation between typical antigens and the presence of the condition. Management and treatment: The following treatments have lead to some pain reduction in patients with Dercum's disease: Liposuction, analgesics, lidocaine, methotrexate and infliximab, interferon α-2b, corticosteroids, calcium-channel modulators and rapid cycling hypobaric pressure. As none of the treatments have led to long lasting complete pain reduction and revolutionary results, we propose that Dercum's disease should be treated in multidisciplinary teams specialised in chronic pain. Prognosis: The pain in Dercum's disease seems to be relatively constant over time.

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Section: Differential Diagnosesmentioning

confidence: 99%

Review of Dercum’s disease and proposal of diagnostic criteria, diagnostic methods, classification and management

Hansson

Svensson

Brorson

2012

Orphanet J Rare Dis

105

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“…No epidermal changes. [18] Bilateral and symmetrical distribution [19] Lipodermatosclerosis Venous stasis Acute inflammatory phase followed by Fibrin deposits around capillaries [20] fibrosis of subcutaneous tissue, nonpitting edema, and hyperpigmentation. Proximal leg edema and distal swelling result in 'inverted wine bottle' appearance [20,21] Papillomatosis cutis Undefined Verrucous growths and partially Epitheliomatous hyperplasia [4,8] carcinoides ulcerated tumors on an edematous extremity [4,8] Papular mucinosis Undefined Multiple waxy papules, may coalesce Acid glycosaminoglycan deposition in the (lichen myxedematosus) into plaques [22] papillary dermis [22] Pretibial myxedema Hyperthyroidism/Grave disease Hyperpigmentation, non-pitting edema, Increased hyaluronic acid (hyaluronan) and nodules, and plaques affecting anterior chondroitin sulfates in dermis, compression surface of legs and dorsa of feet.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Full body skin examination, Stremmer's sign (thickening of skin on dorsal toes, indicative of lymphedema) [1,18] Laboratory Thyroid-secreting hormone and complete blood count with differential to evaluate for eosinophilia If filariasis is suspected, Giemsa-stained blood smear to evaluate for microfilariae and/or specific antigen testing [2] Fungal culture if chromoblastomycosis is suspected…”

Section: Physical Examinationmentioning

confidence: 99%

Elephantiasis Nostras Verrucosa

Sisto

Khachemoune

2008

American Journal of Clinical Dermatology

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Elephantiasis nostras verrucosa (ENV) is a rare and dramatic sequela of chronic nonfilarial lymphedema. The condition is characterized by papules, verrucous lesions, enlargement, and woody fibrosis of the affected area. ENV is a progressive condition, and, without intervention, ongoing deformity and disability will result. Management of ENV is often challenging, but a variety of successful medical and surgical treatment strategies have been reported.

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“…Such methods will show a thickening of the skin and subcutis in the case of lipoedema. Unlike lymphoedema, there is no "honeycomblike" structure of the subcutis or a collection of oedema fluid (29,(35)(36).…”

Section: Aetiologymentioning

confidence: 99%

Treatment of lipoedema using liposuction

Rapprich¹,

Baum²,

Kaak³

et al. 2015

Phlebologie

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SummaryBackground: Lipedema is a painful, genetically induced, abnormal deposition of subcutaneous fat in the extremities of women. The pathogenesis is unknown. Also unknown is the number of women affected in Germany. This study presents the epidemiology of the disease. There are currently two treatment options available: Complex physical decongestive therapy and liposuction. Liposuction is the only method that removes fat permanently. An additional study proves its effectiveness and highlights its vital role as part of a comprehensive treatment concept. Patients and methods: As part of the epidemiological research, all patients of a general practioner were examined for leg problems. The liposuction study included the preand postoperative examination of 85 patients, which was carried out using a questionnaire. Results: Lipedema were diagnosed in 5 % of all patients of the GP practice. In all 85 pa-

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Lipedema, a frequently unrecognized problem

Cited by 61 publications

References 8 publications

Review of Dercum’s disease and proposal of diagnostic criteria, diagnostic methods, classification and management

Review of Dercum’s disease and proposal of diagnostic criteria, diagnostic methods, classification and management

Elephantiasis Nostras Verrucosa

Treatment of lipoedema using liposuction

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