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.
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