Update in the management of lipedema

Abstract

Introduction: Lipedema is a chronic feminine disease that causes abnormal fat deposition in lower limbs and occasionally upper limbs. Easy bruising and pain are common. Lipedema patients suffer from both physical and psychological disability. Despite the relatively high prevalence and the impact on the quality of life, little is known about the disease. Most patients are misdiagnosed as lymphedema or obesity. The aim was to perform a non-systematic review on lipedema literature, related to diagnosis and therapy. Evidence acquisition: A literature search was performed by three researchers, to retrieve pertinent articles in PubMed 5 Web of Science 6 and ResearchGate 7 from the last 20 years. The documents were selected from systematic reviews, reviews, meta-analyses, consensus documents and guidelines, randomized controlled trials and retrospective, cohort and clinical series. Evidence synthesis: Regarding pathophysiology, alterations are not exclusively confined to adipose tissue. Lymphatic dysfunction, cardiovascular variations, blood capillary fragility and increased permeability are common. Patients often present with neurological alterations and hormonal malfunction. Elevated cutaneous sodium has been documented. Due to the absence of a defined etiology, evidence-based research is difficult in the management of lipedema. Conclusions: The setting of realistic expectations is important for both patient and medical care provider. The major aims of the management are multimodal for improvements in the quality of life; reduction in heaviness and pain, reshaping the affected limbs, weight control, improvements in mobility. Compression garments, physical therapy, exercise regimens, diet and psychological counseling are necessities. For selected patients, surgical treatment is an added option.

Lipedema subsequent with lymphedema and obesity in male patient: a rare case

“…These methods can remove existing fat deposit, but further deposit must be prevented. 4,12 In the present case, treatment is emphasized to alleviate pain and control blood pressure. Medication of NSAID, proton pump inhibitors, and antihypertensive were given.…”

Body Composition Assessment by Dual-Energy X-Ray Absorptiometry: A Useful Tool for the Diagnosis of Lipedema

“…Diagnosis of lipedema, as well as its classification into different types and stages, was made according to predefined clinical criteria [6, 30, 31], as outlined in Figure 1. In particular, diagnosis was retained when all the following clinical criteria were met: (i) disproportionate body fat distribution with bilateral and symmetrical enlargement of the limbs and minimal or no involvement of hands and feet; (ii) no or limited influence of weight loss on fat distribution; (iii) limb pain, tenderness, and easy bruising; (iv) increased sensitivity to touch or limb fatigue; (v) minimal or no pitting edema; (vi) no reduction of pain or discomfort with limb elevation.…”

Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023

“…The diagnosis is mainly clinical [ 173 ], with a differential diagnosis that is not unlike lymphedema (see Section 6.0). In fact, some suggest that most cases of lipedema are misdiagnosed as lymphedema or obesity [ 174 ]. Diagnostic testing is largely performed to rule out competing diagnoses (see Section 6.3 ), and may include blood testing for causes of edema, as well as ultrasound, CT, or MRI of the extremity skin.…”

“…Lipedema may present similar quality of life and self-esteem challenges as described with lymphedema (Section 6.5 ). As such, additional treatment considerations include psychosocial therapy and patient education on self-management [ 173 , 174 ].…”