What is lipoedema?
Lipoedema (American spelling lipedema) is characterised by abnormal fat deposition resulting in large legs that are greatly out of proportion to overall body size. It is often painful, so may also be called painful fat syndrome.
Who gets lipoedema?
Lipoedema is nearly always seen in women. It develops soon after puberty and gradually progresses.
Although lipoedema tends to be worse in the overweight or obese, it may also affect women of normal weight. There is often a family history of the disorder.
Clinical features of lipoedema
Lipoedema affects the hips, buttocks, thighs and/or the lower legs symmetrically, but feet are rarely affected. The abnormal fat deposition often creates a ring of fatty tissue overlapping the top of the feet (cuffing sign). It occasionally affects the upper limbs. Swelling may be worse in the evening or when hot.
Overlying skin appears quite normal. The swelling does not pit on pressing it with a finger.
Classification of lipoedema
Lipoedema is classified by distribution and severity of fat deposition.
- Type 1: buttocks and thighs
- Type 2: extends to include knees
- Type 3: includes ankleseverity
- Type 4: involves arms as well as legs
- Type 5: lipo-lymphoedema
- Stage 1: Soft consistency of fatty tissue with normal skin surface
- Stage 2: Nodular consistency with uneven skin surface
- Stage 3: Lobular deformation with variable nodules and peau d'orange appearance to skin surface
What are the complications of lipoedema?
Lipoedema can be tender and painful, and easy bruising occurs due to capillary weakness. In time, it can be complicated by lymphoedema; the combination of lipoedema and lymphatic insufficiency is called lipo-lymphoedema or lympho-lipoedema.
Increasing weight of the lower limbs can lead to orthopaedic problems.
How is lipoedema diagnosed?
Lipoedema is diagnosed by its clinical features. It fails to improve on compression, if this is used following misdiagnosis of lymphoedema, in which swelling is due to the accumulation of lymph, a protein-rich fluid. However, lymphoedema may also develop within longstanding lipoedema (lipolymphoedema). This is recognised by the development of irregular lumps, and progression of swelling to involve the feet.
Lipoedema should be distinguished from simple obesity, which affects the whole body, and Dercum disease, which occurs at a later age and is due to lipoma deposition on trunk and limbs.
These are not usually necessary.
- Ultrasound examination of lipoedema may show normal dermis, and thickened subcutis with increased echogenicity. In contrast, lymphoedema has increased dermal thickness and decreased echogenicity.
- CT scan shows thickened skin alone in lipoedema, and fluid accumulation, honeycomb pattern and muscle enlargement in lymphoedema.
- MRI is sometimes used to evalulate lymphatic circulation.
What is the treatment for lipoedema?
Treatment is generally unhelpful. It persists even when considerable weight is lost from other areas of the body with the help of dieting and exercise. Lipoedema is not affected by diuretics, elevation or compression. In fact, compression is usually intolerable because it aggravates the pain associated with lipoedema.
If there is lipo-lymphoedema, manual lymphatic drainage and compression may be of some benefit.
Lipectomy (surgery to cut out fat) or liposuction may be hazardous as they risk damaging the lymphatic vessels. However, tumescent liposuction has been reported to be a highly effective treatment for lipoedema with good morphological and functional long–term results.
How can lipoedema be prevented?
What is the outlook for
Lipoedema persists lifelong.