Weekly Article

Lipedema

Defined:

Lipedema is a chronic disease seen in females with symmetrical impairment of fatty tissue distribution and the tendency to orthostatic edema. (Orthostatic edema is defined as a disorder characterized by edema that becomes detectable after a period of time (no more than 12 hr.) in the sitting or standing posture and that disappears spontaneously in recumbency).

Symptoms:

Typical symptoms are symmetrical distribution of fat and edema in the lower extremity usually in the thighs, hip, and lower legs. The area is sensitive to pressure and has easy bruising. The feet will be normal with no edema. There can be a genetic factor so other family member may have this as well. Most people present with a marked discrepancy between their slim upper body and the chunky lower body.

Stages:

In the initial stages, the skin is smooth with thickened subcutaneous layer and evenly distributed small nodules. With time, the nodules become enlarged causing the skin surface to be uneven.

Onset:

The onset is usually in puberty but also can occur after pregnancy or menopause.

Patient history:

Women with lipedema report a spontaneously occurring feeling of tension or swelling as well as a noticeable hypersensitivity of touch and pressure in the thighs and lower legs. The complaints generally become worse as the day progresses, particularly after standing or sitting for extended periods. In addition, edema, generally occurring in the evening and with higher frequency in warm weather, is reported. Patients also report that even minor bumps result in bruising. The patients’ appearance causes them major distress. Many women describe their frustration as their condition deteriorates, often leading them to overeat and consequently gain weight. (Lymphedema Diagnosis and Therapy by Horst Weissleder and Christian Schuchhardt fourth edition)

Therapy:

Physicians because of lack of awareness, may prescribe counterproductive treatment, including dieting, training and toning the affected body parts and drugs. Because of the extreme symptoms, nearly all patients try some sort of dieting regimen. However, this only helps treat obesity and reduce the circumference of the trunk. Since the fat deposits specific to lipedema cannot be “starved off,” Dieting may lead to an even greater discrepancy between the trunk and the extremities. Burning calories through physical exercise also does not lead to the desired reduction of fat at the affected areas. (Lymphedema Diagnosis and Therapy by Horst Weissleder and Christian Schuchhardt fourth edition)

What should you do?

Manual Lymph Drainage and compression garments are used to reduce edema. We aim to increase the transport volume of the lymph collectors. Compression bandages combined with physical therapy is used to reduce and prevent swelling.