Diagnosis and management

• diagnosis is frequently missed because clinicians lack familiarity with lipoedema and because it clinically resembles lymphoedema
  • lipedema results from the subcutaneous deposition of fat and occurs independently of lymphatic or venous insufficiency
  • patient history and physical examination are usually sufficient to differentiate lipoedema from lymphoedema
    • although there may be a blurring of the clinical features of these two conditions when lipoedema has persisted for several years
    • patients with severe, long-standing lipoedema may eventually develop mechanical insufficiency of the lymphatic system and superimposed lymphoedema, producing "lipolymphoedema"
    • in lipolymphoedema, the initially soft lipedematous tissue may become firm and nodular. Foot enlargement, including a positive Stemmer's sign, may develop
      • a positive Stemmer's sign is a skin fold at the base of the second toe too thick to lift
  • MRI
    • findings include a homogenous increase in subcutaneous fat with little/no fibrosis; no skin thickening
• treatment options for lipoedema are limited
  • dieting, diuretics, leg elevation, and compression appear to be of minimal benefit
    • long-term low-level compression therapy is unlikely to reverse lipoedema it may help prevent its worsening and progression to lipolymph-edema
  • attempts to treat invasively via lipectomy or liposuction are not recommended because they risk causing mechanical damage to the lymphatics

Reference:

• 1) Fonder MA et al. Lipedema, a frequently unrecognized problem Journal of the American Academy of Dermatology 2007; 57 (2): S1-S3.