Lipedema - fat on the limbs

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03 aug 2023

Lipedema - a chronic progressive condition characterized by uneven distribution of adipose tissue, which leads to a discrepancy between the volume and shape of the limbs and trunk. This abnormal distribution of fatty tissue appears symmetrically, more often on the lower extremities, but sometimes on the upper ones. For the treatment of lipedema, the use of compression products is extremely important.

 

What is lipedema?

 

Lipedema is a pathological condition characterized by an abnormal accumulation of fat cells in the extremities, predominantly in the legs. It is often misunderstood as being simply overweight or obese, but it is not actually related to this factor. Lipedema occurs predominantly in women, and it is suggested that its causes may be related to hormonal factors. Lipedema and lymphedema are two different diseases.

Women suffering from lipedema may notice that even with diet and physical activity, their legs (or, less commonly, arms) continue to gain weight, as the level of fat accumulation remains the same despite a decrease in calories consumed.

 

 

Causes of lipedema

 

The cause of lipedema is not fully understood due to the lack of research in this area. However, experts believe that genetic predisposition and hormonal imbalances play a key role in the development of this condition.

It is believed that lipedema can often occur during puberty in women. Also, its appearance may be associated with the use of oral contraceptives, pregnancy and menopause. In men, similar changes resembling lipedema have been described with the use of hormonally active drugs, as well as in the case of a pronounced hormonal imbalance, for example, in hypogonadism, or in the presence of cirrhosis of the liver.

 

 

Types of lipedema

 

Lipedema includes 5 main types, with types 1-3 being the most common. It is important to note that some patients may present with a combination of different types:

Type 1: Affects the pelvis, buttocks, and thighs.
Type 2: covers the buttocks up to the knees and is accompanied by the formation of fat folds around the inside of the knees.
Type 3: Affects the buttocks and extends to the ankles.
Type 4: Affects the arm area.
Type 5: Affects the lower legs.

 

Signs and symptoms of lipedema

 

1. Significant tissue enlargement, usually symmetrical and affecting the lower legs, thighs, flanks, and/or buttocks. The areas of the hands are usually not affected.
2. Pain and extreme sensitivity to touch and pressure on affected areas.
3. Swelling and feeling of heaviness in the affected limbs.
4. Limited mobility and muscle weakness.
5. Formation of "cuffs" or "bracelets" on the ankles or wrists, where the expansion of the tissue is abruptly interrupted in front of the feet or hands, which are usually not affected.
6. Disappearance of concave spaces on either side of the Achilles tendon.
7. Tendency to bruise the affected areas for no apparent reason.
8. Change in appearance, temperature, and texture of the skin in the affected areas, which becomes softer, cooler, and may resemble an orange peel with indentations.
9. Improper gait, limited mobility and muscle weakness.
10. Negative sign of Kaposi-Stemmer, in which it is impossible to collect and lift the skin at the base of the second toe or middle finger.
11. Pastous edema may be present in some patients with lipedema, lipolymphedema, and/or chronic venous insufficiency (CVI), but is usually absent in the early stages of lipedema. It indicates an excess of interstitial fluid.

These symptoms may vary from patient to patient and the diagnosis of lipedema should be made by a qualified medical professional based on clinical examination and additional investigations.

 

Stages of lipedema

 

1. Stage I: The skin appears smooth, and the subcutaneous tissue is evenly thickened and soft on palpation.
2. Stage II: An uneven texture appears on the skin, resembling an orange peel. On palpation, subcutaneous nodules of various sizes can be detected.
3. Stage III: The increase in subcutaneous adipose tissue continues, and the lumps become larger and more noticeable than in stage II. Deformed deposits of lobular fat appear, which can significantly distort the profile of the limb.
4. Stage IV: Presence of lipolymphedema" is not mentioned in the previous report and may be a clarification or additional information regarding the diagnosis of lipoedema. Lipolymphoedema is a condition in which lipoedema coexists with lymphoedema, which can exacerbate swelling and problems with the lymphatic system.

The diagnosis and staging of lipedema should be established by an experienced medical professional based on the patient's examination, medical history, and additional investigations as needed.

 

The mechanisms of development of lipedema include the following aspects:

 

1. Increased fat volume: Lipedema is characterized by an increase in fat cells (adipocytes) in certain areas of the body. This may be due to an increase in the size of adipocytes (hypertrophy) or an increase in their number (hyperplasia).
2. Oxygen deficiency in adipose tissue: An increased amount of adipose tissue can create conditions for lack of oxygen in some areas, which can contribute to the development of bruising.
   Decreased elasticity of the skin and connective tissue: The progressive increase in adipose tissue can lead to a loss of elasticity in the skin and connective tissue, which in turn contributes to the appearance of the characteristic "orange peel" texture.
3. Compression of nerve fibers: The increase in adipose tissue can lead to compression of the nerve fibers, which can cause pain and hypersensitivity in the affected areas.
   Development of edema (lipolymphedema): Lipedema may be accompanied by the formation of edema associated with an increase in the amount of interstitial fluid.
4. This can be caused by various factors such as capillary damage, lymphatic obstruction, reduced mobility, and others.

It is important to note that the exact causes of lipedema are still not fully understood, and research in this area is ongoing. Lipedema is a complex medical condition, and the exact mechanism by which it develops can vary from patient to patient.

Treatment of lipedema

 

Prevention of the development of lipedema is not possible, since the causes of its occurrence are still not known. However, a healthy lifestyle, including a balanced diet and physical activity, can help improve overall health and reduce possible complications.

If lipedema has already been diagnosed, you should contact a medical specialist to draw up an individual treatment plan. Treatment for lipedema usually involves a combination of different methods:

1. Physiotherapy: Includes manual lymphatic drainage, compression stockings, exercise, and skin care. These measures can help improve the flow of lymphatic fluid and reduce swelling.
2. Physical activity: Regular exercise such as walking, swimming, and hiking can help improve circulation and reduce discomfort.
3. Diet therapy: a correct and balanced diet to normalize metabolism significantly accelerates the treatment of lipedma.
4. Psychotherapy: Patients with lipedema may experience psychological difficulties due to their condition. Psychotherapy can help deal with emotional problems and improve self-esteem.
5. Liposuction and Plastic Surgery: In some cases, if conservative treatment fails, surgery such as liposuction may be required.

It is important to discuss all possible treatment options with a medical professional in order to find the best solution for each individual case of lipedema.