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Lipoedema

Author: Hon A/Prof Amanda Oakley, Dermatologist, Health Waikato, Hamilton, New Zealand, 2008

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, thighs and the lower legs symmetrically, but feet are rarely affected. The abnormal fat deposigion often creates a ring of fatty tissue overlapping the top of the feet.

Overlying skin appears quite normal. The swelling does not pit on pressing it with a finger.

How is it 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.

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.

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?

Unknown.

What is the outlook for

Lipoedema persists lifelong.

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