Lipedema, a hardly known disease: diagnosis, associated illnesses and therapy

Abstract

Lipedema is a common but rarely diagnosed disease or frequently confused with obesity. Patients are almost exclusively women. It is characterised by symmetrical, circumscribed, in advanced form deforming fat tissue accumulation on the legs that is associated with lymphedema. Spontaneous pain, pain to pressure and tendency to hematoma are characteristic. One of the possible causes of a fat leg, that is a very common complaint, is lipedema. Main differential diagnoses are obesity, lipohypertrophy and primary and secondary lymphedema. It is often associated with chronic venous and lymphatic insufficiency, early degenerative articular disease and obesity. The disease is rarely recognized and the treatment modalities are not widely known. Therefore patients feel very frustrated that leads to psychologic disorders. Until recently only conservative treatment was possible (combination of manual or intermittent pneumatic drainage, compression bandages and garments and physiotherapy). More recently surgical intervention (liposuction) is also included in the treatment options. The significance of lipedema is due not only to the disease itself, but also to the combination of lipedema and the group of associated and secondary diseases (articular and venous diseases, lymphedema, obesity, psychologic disorders). The more diseases coexist, the worse is the prognosis of lipedema itself. To prevent and delay this disease, it is indispensable to recognise it as early as possible and to treat it expertly and follow up patients suffering from lipedema.

Lipedema: A Call to Action!

“…Although not pathognomonic, and in spite of a lack of high-quality scientific data, microangiopathy has been considered a typical histological feature of lipedema by some researchers (7). This vascular alteration may be a consequence of the primary endothelial dysfunction through hypoxia mechanism with subsequent increased vascular fragility, similar to what was observed in patients with diabetic retinopathy (39). Angiogenesis has several stimulators, including VEGF.…”

Rare adipose disorders (RADs) masquerading as obesity

“…Painful SAT is a chronic problem in lipedema [111,114] . The excess tissue fluid weakens nearby structures leading to the development of joint pains; with progression of lipedema, arthritis develops [149] . Capillary fragility, ecchymosis, hematomas and venous varicosities are common [150] .…”

Pathophysiological dilemmas of lipedema

“…If an altered ER pattern also exists centrally (not only in the adipose tissue), this may provide a hypothetic explanation for difficulties in weight loss in patients suffering from lipedema [2]. The experience is to be elucidated why some patients can lose weight from almost everywhere except for the lipedematous area [43]. A summary of the potential mechanism of action of estrogen is shown by Fig.…”