Lipoedema

Lipoedema is a chronic medical condition characterised by the excessive deposition of fat in the legs, predominantly affecting women.

This disease leads to the enlargement of both legs due to fat deposits under the skin, often resulting in pain, easy bruising, and reduced mobility. Despite its prevalence, lipoedema is commonly misdiagnosed as obesity or lymphedema.

Signs & Symptoms

Lipoedema typically presents with increased fat deposits under the skin in the legs, increased extracellular fluid, and inflammation. Patients often experience pain and easy bruising. As the condition progresses, mobility may be reduced, and patients may suffer from depression due to decreased quality of life.

In severe cases, fat deposits may extend to the trunk and upper body. Associated conditions include joint pain, arthritis, dry skin, fungal infections, cellulitis, and slow wound healing.

Cause

The exact cause of lipoedema remains unknown, but it is believed to involve genetic and hormonal factors. The condition often appears during hormonal changes such as puberty, pregnancy, and menopause, suggesting a hormonal component. Familial clusters of lipoedema have been identified, highlighting a potential genetic predisposition. While obesity can co-occur with lipoedema, it is not the cause of the condition.

Diagnosis

Diagnosing lipoedema involves differentiating it from other conditions such as lymphedema, obesity, and chronic venous insufficiency. Key diagnostic features include the presence of non-pitting oedema, pain in the affected areas, and a negative Stemmer's sign. Unlike other forms of fat, lipoedema fat is resistant to traditional weight-loss methods and is not associated with an increased risk of diabetes or cardiovascular disease.

Differential Diagnosis

• Lipoedema: Fat deposits in legs and arms, sparing hands and feet; non-pitting oedema; pain; negative Stemmer's sign.
• Lipo-lymphedema: Fat deposits in legs/arms/torso; pitting and non-pitting oedema; positive Stemmer's sign; pain.
• Lymphedema: Swelling in one limb including hands and feet; pitting oedema; no initial pain; positive Stemmer's sign.
• Obesity: Widespread fat deposits; diets and weight loss strategies effective; no oedema.
• Venous insufficiency: Swelling near ankles; brownish discolouration of lower legs; minimal swelling; no pain.

Lipoedema Stages

• Stage 1: Normal skin surface with enlarged hypodermis.
• Stage 2: Uneven skin with indentations and larger hypodermal masses.
• Stage 3: Bulky extrusions of skin and fat causing significant deformations, particularly around the thighs and knees, severely inhibiting mobility.

Treatment

Treatment aims to manage symptoms and improve quality of life. Conservative treatments include physiotherapy, light exercise, manual lymphatic drainage (MLD), and compression garments. These methods help maintain mobility, reduce pain, and manage fluid retention.

Surgical options, such as tumescent liposuction, offer significant relief but are not universally adopted. Tumescent liposuction involves the use of tumescent local anaesthesia (TLA) and can be performed using Suction-Assisted Liposuction (SAL) or Power-Assisted Liposuction (PAL). Multiple procedures may be necessary for optimal results. Water Assisted Liposuction (WAL), a variant developed in Germany, is also considered lymph-sparing and protective of other tissues.

Prognosis

There is no cure for lipoedema. Complications include reduced functionality, poor quality of life, depression, anxiety, and chronic pain.

Epidemiology

Lipoedema affects up to 11% of women, according to epidemiological studies. Rates between 6% and 39% have been reported in various studies, reflecting potential underdiagnosis and misdiagnosis.

History

Lipoedema was first identified in the United States at the Mayo Clinic in 1940. Despite being recognised for decades, it remains relatively unknown among healthcare providers and patients, often being mistaken for obesity or lymphedema.

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Self-assessment MCQs (single best answer)

What is lipoedema primarily characterised by?

Which of the following is a common misdiagnosis of lipoedema?

What is a key diagnostic feature of lipoedema?

During which hormonal changes is lipoedema most likely to appear?

Which of the following is NOT a symptom of lipoedema?

What stage of lipoedema is characterised by bulky extrusions of skin and fat causing significant deformations?

Which treatment method is NOT considered a conservative treatment for lipoedema?

Which of the following statements about obesity and lipoedema is true?

Which diagnostic sign is negative in lipoedema but positive in lymphedema?

What percentage of women are affected by lipoedema according to epidemiological studies?