http://www.lymphedema-therapy.com/Lipedema.htm
Lipedema
--------------------------------------------------------------------------------
Overview
and Etiology.
The term lipedema was first used by Allen and Hines (1940) to
describe a symmetrical "swelling" of both
legs, extending from the
hips to the ankles, caused by deposits of subcutaneous adipose (fatty) tissue.
The
underlying etiology of these fat deposits remains unknown. While
lipedema is not a disorder of the
lymphatic system per se, it is
frequently confused with bilateral lower extremity lymphedema. It occurs
almost exclusively in women and may have an associated family history
(20 per cent of cases) and is
usually accompanied by hormonal
disorders as well (Strossenreuther, 1999). If present in a man, it is
accompanied
by massive hormonal disorder.
Fat in the lower extremities extends to the
malleoli (ankle bones), often with flaps of tissue hanging over
the foot. The feet are not affected; occasionally, lipedema is found in the arms. Typically, there are also
fatty bulges in the medial proximal thigh
and the medial distal thigh, just above the knee. Clinically, the
affected individuals complain of pitting edema as the day progresses,
which is relieved by prolonged
elevation of the leg(s) overnight
(Rank and Wong, 1966; Rudkin and Miller, 1994; Casley-Smith, 1997).
Stages
of Lipedema.
In Stage I, the skin is still soft and regular, but nodular changes can be felt upon palpation (see photo #1).
There are no
color changes in the skin and the subcutaneous tissues have a spongy feel, like
a soft rubber
doll. In Stage II, the subcutaneous tissue becomes
more nodular and tough. Large fatty lobules begin to
form on the
medial distal and proximal thigh and medial and lateral ankles just above the
malleoli (see
photo # 2). Pitting edema is common, increasing as
the day progresses. The individual may report
hypersensitivity over
the anterior tibial (shin) area. Skin color changes occur in the lower leg,
indicative of
secondary lymphedema, which often occurs in later
stage lipedema.
Pathophysiology of Lipedema (Strossenreuther,
1999).
There are many histological and physiological changes that occur in
lipedema. There is a decrease in the
elasticity of the skin and
underlying connective tissue. The basement membrane of blood vessels is
thickened and there are disturbances in vasomotion. There is decreased
vascular resistance, increased
skin perfusion, and increased
capillary filtration. There is increased venous/blood capillary pressure
causing increased ultrafiltration. These vascular changes combined with
the decreased efficiency of the
calf muscle pump, result in both
the dependent pitting edema seen in Stage I, as well as the the secondary
lymphedema that often complicates lipedema in its later stages.
Histological changes seen in lipedema
include a thinning of the epidermal layer, thickening of the subcutaneous tissue layer, fibrosis of arterioles,
tearing of elastic fibers, dilated venules and
capillaries, and hypertrophy and hyperplasia of fat cells.
Clinical
studies show that there is enlargement of the pre-lymphatic channels (Stoberl
et al., 1986) as well
as defects in capillary perfusion (Weinert
and Leeman, 1991). Some authors have reported no alteration
in
lymphatic transport (Brautigam et al., 1998) while others (Bilancini et al.,
1995) have reported
decreased lymph outflow in those individuals
with lipedema. Foldi and Foldi (1993) reported an increase
in fat
cell growth during lymphostasis.
Medical Management
Diagnosis. The
diagnosis of lipedema is difficult if the clinician is unfamiliar with this
condition. Often, these
people are told that they are "fat" and
should just lose weight to resolve the problem. For reasons still
unknown, the fatty tissue accompanying this condition cannot be
significantly decreased by diet. It is not
uncommon for a diagnosis
of primary lymphedema to be made. This results in frustration for the person
who then seeks out lymphedema therapy with poor
results.
There are several significant clinical differences between
lipedema and bilateral primary lymphedema. The
feet are not
involved in lipedema; while they are edematous with a positive Stemmer's sign
in
lymphedema, Stemmer's sign is negative in lipedema (see fig.
12-17). The "swelling" in lipedema is
symmetrical, while in primary
lymphedema usually one limb is more involved than the other. The
subcutaneous tissues feel rubbery in lipedema. In advanced Stage II
lymphedema, there is significant
subcutaneous fibrosis, which feels
firmer than lipedema.
While there have been reported incidences of
cellulitis in Stage II lipedema (usually with a component of
lymphedema as well), the frequency of cellulitis in Stage II lymphedema
is much higher. The time of onset
of the "swelling" in lipedema is
usually around puberty and 90 per cent of these cases have accompanying
diagnoses of hormonal disturbance (thyroid, pituitary, or ovarian).
This is usually not the case with primary
lymphedema.
A
lymphoscintigram may be helpful to differentiate between lymphedema and
lipedema, however, there
can be conflicting results as lymphedema
often occurs to some degree in the later stages of lipedema,
probably due to impairment of lymph flow caused by the pressure of
fatty tissue. In fact, there are clinical
cases of bilateral lower
extremity lymphedema in the morbidly obese individual; the onset of the
lymphedema occurs after body weight exceeds 350-400 pounds. It is
plausible to suspect that the
pressure of a large apron of abdominal
fat can effectively block lymph flow through the inguinal area
causing the lymphedema but there is a difference between these cases
and lipedema because obesity does
not cause lipedema. Lipedema is
caused by a hormonal imbalance resulting in excessive deposition of
adipose tissue, most often in the lower extremities (see Figs. 12-21;
12-22) although it can occur in the
upper extremities as
well.
Treatment and Prognosis.
There is no effective medical
treatment for lipedema and the prognosis is guarded; however, significant
functional improvements are possible with good program compliance and
therapy intervention. Medical
management involves treating the
hormonal disturbance as effectively as possible and providing nutritional
guidance to avoid additional weight gain. Many of these individuals
have endured years of ridicule
because of their physical appearance
and become recluses in their homes, further limiting their activity
level. As lipedema progresses and the hypersensitivity increases, they
feel less inclined to walk or exercise
because of the pain. They
inevitably gain more weight due to the inactivity and depression, often finding
food their only comfort.
The primary goal of therapy
intervention in the person with lipedema is symptomatic relief and realistic
improvement of trunk and lower extremity function. Application of
the combined lymphedema treatments
has shown some success in
relieving the pain and hypersensitivity in the lower legs and improving general
mobility. Usually, a lower level of compression is needed to
support a lipedematous limb, compared to a
lymphedematous limb of
the same size and girth. This guideline applies to the compression garments as
well. These individuals often require more padding under the
compression bandages, particularly in the
anterior tibial area.
They do not tolerate the heavier, denser compression fabrics and usually
require a
lower grade compression garment than someone with
uncomplicated lymphedema. The therapist must
remember, however,
that later stage lipedema is often accompanied by lymphedema as well, and the
treatment and management must take that factor into consideration
when recommending exercise and
garments.
The main goals of
intervention are to decrease pain and hypersensitivity, to decrease the
lymphedematous
component of the disease, and to assist the
individual in maintaining and/or reducing adipose tissue
through
exercise and nutritional guidance. The compression garments can help to
decrease the adipose
tissue with exercise and weight loss. The most
difficult task is fitting the compression garments. They must
be
custom made due to the large size of the individual and are often uncomfortable
at the waist,
particularly when sitting. Making the radical change
in daily activity level is most challenging for these
individuals.
Providing continued support and encouragement is important.
Networking is
helpful and is facilitated by offering a support group, even when held on an
irregular,
informal basis. An hour-long educational meeting, even if
only offered three or four times per year can
provide a neutral
meeting place for people to begin networking. Nothing can compare to the
encouragement and hope that an individual with lipedema/lymphedema can
derive from seeing and talking
with someone else living with the
same problem and hearing how others cope on a day-to-day basis.
Therapists can learn some of the best guidance on exercise and coping
with garments in a group like
this.
--------------------------------------------------------------------------------
Lymphedema
Therapy
77 Froehlich Farm Blvd., Woodbury, New York 11797
1-800-MD-LYMPH
or (516) 364-2200
Marvin Boris, MD
Stanley Weindorf, MD
Bonnie B.
Lasinski, MA, PT, CI, CLT-LANA
-----------------------------------
A Closer Look at Lipedema and the Effects on the Lymphatic System
By Joachim Zuther, on December 13th, 2012
Lipedema is characterized by symmetric enlargement of the limbs, generally
affecting the lower extremities extending from the hips to the ankles secondary
to the deposition of fat; upper extremities are affected in 30% (1) of the
cases.
Lipedema is not rare and not caused by a disorder of the lymphatic system,
but is commonly misdiagnosed as bilateral lymphedema, extreme cellulitis, or
morbid obesity.
Most commonly used synonyms for lipedema include:
This condition almost exclusively affects women; according to an epidemiologic study by Földi E. and Földi M.(2),
lipedema affects 11% of the female population, and literature suggests that
lipedema is associated with extensive hormonal disorders or liver dysfunctions
if present in males.
Lipedema is a painful fat disorder and if left untreated can cause multiple
secondary health problems, to include mobility issues and lymphedema. The
quality of life, emotionally and physically, for individuals affected by
lipedema is often decreased due to the fact that the condition is typically
dismissed as simple obesity by clinicians unfamiliar with the symptoms.
The underlying cause for the development of lipedema remains unknown; it is
thought to be associated with hormonal disorders and can be hereditary with 14%
of affected individuals having a family history of lipedema (3). Lipedema can
develop early in puberty; however, the mean age of diagnosis is approximately
35.
Lipedema can be diagnosed based on clinical criteria (history, typical
clinical features) and by physical examination rather than with diagnostic
tests.
Clinical Features:
For the purpose of this forum, the additional swelling that develops in the
later hours of the day in lipedema is of particular interest and is indicative
for the involvement of the lymphatic system if lipedema remains without proper
management.
Corkscrew-like appearance of lymph collectors in
lipedema
The excessive amount of fatty tissue present in lipedema compresses the lymph
collectors of the superficial lymphatic system, which are embedded in the fatty
subcutaneous tissue. Lymphangiographic imaging shows that the lymph collectors
within the proliferated fatty tissue have a coiled or corkscrew-like appearance
rather than passing fairly straight towards the lymph nodes as is the case in
healthy tissue. This can result in a reduced transport capacity of the
lymphatic system in the affected area.
If the capacity of the lymphatic system is reduced to such an extent that it
becomes unable to perform one of its basic functions, the removal of water from
the tissues, fluid will accumulate and “real” edema develops in addition to
lipedema.
In the initial stages the swelling may recede with elevation and
rest, but over time and without adequate treatment (compression, elevation,
exercise), the constant strain on the lymphatic system may cause damage to the
lymphatic vessels, leading to further reduction of its transport capacity, and
swelling may be constantly present.
Lipo-lymphedema
As a result of prolonged overstrain of the lymphatic system, lymphedema may
develop secondary to lipedema (lipo-lymphedema), thereby increasing the
complexity of treatment. If lipo-lymphedema remains without treatment, it will
progress through the same stages as primary or secondary lymphedema.
Treatment
Active treatment for lipedema is necessary because early diagnosis and
treatment can determine the individual’s long-term prognosis. Therapy for
lipedema can be largely divided into conservative treatments to reduce edema,
and surgical treatments such as liposuction.
Main goals in the conservative
treatment of lipedema are to decrease pain and hypersensitivity, increase
mobility and to prevent, or if already present, to address the edematous
component associated with lipedema. If lipedema, or lipo-lymphedema is
associated with obesity, nutritional guidance must be provided to reduce weight
and avoid further weight gain.
Conservative approaches include complete decongestive therapy (CDT); CDT does not
address proliferated fatty tissue, but contributes to the reduction of edema
and the prevention of the manifestation of lipo-lymphedema. The various
components of CDT also contribute to reducing pain and hypersensitivity to
pressure.
In most cases it is necessary to apply a lower level of
compression (bandages and compression garments) due to pain and
hypersensitivity in the affected areas. Compression garments generally have to
be custom-made to the individuals’ measurements. If the use of compression
garments is discontinued, edema will return.
Surgical treatment may be considered for patients with lipedema who do not
respond to conservative treatment. Liposuction is currently the standard
surgical treatment method; however, this procedure may cause bleeding and
secondary damage to lymph vessels resulting in persistent swelling. New and
more advanced techniques may reduce these risks; however, individuals
considering this approach should ensure that the performing physician is
experienced and follows internationally established guidelines.
Postoperatively, there is generally an increased tendency for swelling, thus
CDT should be initiated or continued within a few days of the procedure.
In the presence of additional lymphedema (lipo-lymphedema) the treatment
protocol for complete decongestive therapy corresponds with that for primary
lymphedema. CDT shows good long-term results in lipo-lymphedema; however
affected individuals need to understand that, although the lymphedemateous
component responds well and generally relatively fast to CDT, the lipedema
itself, i.e. the reduction of fatty tissue responds more slowly, and sometimes
not at all. According to several authors, reduction of the excessive fatty
tissue in lipedema is possible if compression garments are worn constantly.
(1) Herpertz, U. (1995) Das Lipödem. Lymphologie 19, 1-11
(2) Földi, E., and Földi, M. (2006) Lipedema. In Földi’s Textbook
ofLymphology (Földi, M., and Földi, E., eds) pp. 417-427, Elsevier
GmbH,Munich,Germany
(3) Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S, Mortimer
PS. Lipedema: an inherited condition. Am J Med Genet A. 2010;152A:970–976. [PubMed]
Additional Reading:
http://www.hanse-klinik.com/englisch/Lipoedema.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309375/
Lipedema
--------------------------------------------------------------------------------
Overview
and Etiology.
The term lipedema was first used by Allen and Hines (1940) to
describe a symmetrical "swelling" of both
legs, extending from the
hips to the ankles, caused by deposits of subcutaneous adipose (fatty) tissue.
The
underlying etiology of these fat deposits remains unknown. While
lipedema is not a disorder of the
lymphatic system per se, it is
frequently confused with bilateral lower extremity lymphedema. It occurs
almost exclusively in women and may have an associated family history
(20 per cent of cases) and is
usually accompanied by hormonal
disorders as well (Strossenreuther, 1999). If present in a man, it is
accompanied
by massive hormonal disorder.
Fat in the lower extremities extends to the
malleoli (ankle bones), often with flaps of tissue hanging over
the foot. The feet are not affected; occasionally, lipedema is found in the arms. Typically, there are also
fatty bulges in the medial proximal thigh
and the medial distal thigh, just above the knee. Clinically, the
affected individuals complain of pitting edema as the day progresses,
which is relieved by prolonged
elevation of the leg(s) overnight
(Rank and Wong, 1966; Rudkin and Miller, 1994; Casley-Smith, 1997).
Stages
of Lipedema.
In Stage I, the skin is still soft and regular, but nodular changes can be felt upon palpation (see photo #1).
There are no
color changes in the skin and the subcutaneous tissues have a spongy feel, like
a soft rubber
doll. In Stage II, the subcutaneous tissue becomes
more nodular and tough. Large fatty lobules begin to
form on the
medial distal and proximal thigh and medial and lateral ankles just above the
malleoli (see
photo # 2). Pitting edema is common, increasing as
the day progresses. The individual may report
hypersensitivity over
the anterior tibial (shin) area. Skin color changes occur in the lower leg,
indicative of
secondary lymphedema, which often occurs in later
stage lipedema.
Pathophysiology of Lipedema (Strossenreuther,
1999).
There are many histological and physiological changes that occur in
lipedema. There is a decrease in the
elasticity of the skin and
underlying connective tissue. The basement membrane of blood vessels is
thickened and there are disturbances in vasomotion. There is decreased
vascular resistance, increased
skin perfusion, and increased
capillary filtration. There is increased venous/blood capillary pressure
causing increased ultrafiltration. These vascular changes combined with
the decreased efficiency of the
calf muscle pump, result in both
the dependent pitting edema seen in Stage I, as well as the the secondary
lymphedema that often complicates lipedema in its later stages.
Histological changes seen in lipedema
include a thinning of the epidermal layer, thickening of the subcutaneous tissue layer, fibrosis of arterioles,
tearing of elastic fibers, dilated venules and
capillaries, and hypertrophy and hyperplasia of fat cells.
Clinical
studies show that there is enlargement of the pre-lymphatic channels (Stoberl
et al., 1986) as well
as defects in capillary perfusion (Weinert
and Leeman, 1991). Some authors have reported no alteration
in
lymphatic transport (Brautigam et al., 1998) while others (Bilancini et al.,
1995) have reported
decreased lymph outflow in those individuals
with lipedema. Foldi and Foldi (1993) reported an increase
in fat
cell growth during lymphostasis.
Medical Management
Diagnosis. The
diagnosis of lipedema is difficult if the clinician is unfamiliar with this
condition. Often, these
people are told that they are "fat" and
should just lose weight to resolve the problem. For reasons still
unknown, the fatty tissue accompanying this condition cannot be
significantly decreased by diet. It is not
uncommon for a diagnosis
of primary lymphedema to be made. This results in frustration for the person
who then seeks out lymphedema therapy with poor
results.
There are several significant clinical differences between
lipedema and bilateral primary lymphedema. The
feet are not
involved in lipedema; while they are edematous with a positive Stemmer's sign
in
lymphedema, Stemmer's sign is negative in lipedema (see fig.
12-17). The "swelling" in lipedema is
symmetrical, while in primary
lymphedema usually one limb is more involved than the other. The
subcutaneous tissues feel rubbery in lipedema. In advanced Stage II
lymphedema, there is significant
subcutaneous fibrosis, which feels
firmer than lipedema.
While there have been reported incidences of
cellulitis in Stage II lipedema (usually with a component of
lymphedema as well), the frequency of cellulitis in Stage II lymphedema
is much higher. The time of onset
of the "swelling" in lipedema is
usually around puberty and 90 per cent of these cases have accompanying
diagnoses of hormonal disturbance (thyroid, pituitary, or ovarian).
This is usually not the case with primary
lymphedema.
A
lymphoscintigram may be helpful to differentiate between lymphedema and
lipedema, however, there
can be conflicting results as lymphedema
often occurs to some degree in the later stages of lipedema,
probably due to impairment of lymph flow caused by the pressure of
fatty tissue. In fact, there are clinical
cases of bilateral lower
extremity lymphedema in the morbidly obese individual; the onset of the
lymphedema occurs after body weight exceeds 350-400 pounds. It is
plausible to suspect that the
pressure of a large apron of abdominal
fat can effectively block lymph flow through the inguinal area
causing the lymphedema but there is a difference between these cases
and lipedema because obesity does
not cause lipedema. Lipedema is
caused by a hormonal imbalance resulting in excessive deposition of
adipose tissue, most often in the lower extremities (see Figs. 12-21;
12-22) although it can occur in the
upper extremities as
well.
Treatment and Prognosis.
There is no effective medical
treatment for lipedema and the prognosis is guarded; however, significant
functional improvements are possible with good program compliance and
therapy intervention. Medical
management involves treating the
hormonal disturbance as effectively as possible and providing nutritional
guidance to avoid additional weight gain. Many of these individuals
have endured years of ridicule
because of their physical appearance
and become recluses in their homes, further limiting their activity
level. As lipedema progresses and the hypersensitivity increases, they
feel less inclined to walk or exercise
because of the pain. They
inevitably gain more weight due to the inactivity and depression, often finding
food their only comfort.
The primary goal of therapy
intervention in the person with lipedema is symptomatic relief and realistic
improvement of trunk and lower extremity function. Application of
the combined lymphedema treatments
has shown some success in
relieving the pain and hypersensitivity in the lower legs and improving general
mobility. Usually, a lower level of compression is needed to
support a lipedematous limb, compared to a
lymphedematous limb of
the same size and girth. This guideline applies to the compression garments as
well. These individuals often require more padding under the
compression bandages, particularly in the
anterior tibial area.
They do not tolerate the heavier, denser compression fabrics and usually
require a
lower grade compression garment than someone with
uncomplicated lymphedema. The therapist must
remember, however,
that later stage lipedema is often accompanied by lymphedema as well, and the
treatment and management must take that factor into consideration
when recommending exercise and
garments.
The main goals of
intervention are to decrease pain and hypersensitivity, to decrease the
lymphedematous
component of the disease, and to assist the
individual in maintaining and/or reducing adipose tissue
through
exercise and nutritional guidance. The compression garments can help to
decrease the adipose
tissue with exercise and weight loss. The most
difficult task is fitting the compression garments. They must
be
custom made due to the large size of the individual and are often uncomfortable
at the waist,
particularly when sitting. Making the radical change
in daily activity level is most challenging for these
individuals.
Providing continued support and encouragement is important.
Networking is
helpful and is facilitated by offering a support group, even when held on an
irregular,
informal basis. An hour-long educational meeting, even if
only offered three or four times per year can
provide a neutral
meeting place for people to begin networking. Nothing can compare to the
encouragement and hope that an individual with lipedema/lymphedema can
derive from seeing and talking
with someone else living with the
same problem and hearing how others cope on a day-to-day basis.
Therapists can learn some of the best guidance on exercise and coping
with garments in a group like
this.
--------------------------------------------------------------------------------
Lymphedema
Therapy
77 Froehlich Farm Blvd., Woodbury, New York 11797
1-800-MD-LYMPH
or (516) 364-2200
Marvin Boris, MD
Stanley Weindorf, MD
Bonnie B.
Lasinski, MA, PT, CI, CLT-LANA
-----------------------------------
A Closer Look at Lipedema and the Effects on the Lymphatic System
By Joachim Zuther, on December 13th, 2012
Lipedema is characterized by symmetric enlargement of the limbs, generally
affecting the lower extremities extending from the hips to the ankles secondary
to the deposition of fat; upper extremities are affected in 30% (1) of the
cases.
Lipedema is not rare and not caused by a disorder of the lymphatic system,
but is commonly misdiagnosed as bilateral lymphedema, extreme cellulitis, or
morbid obesity.
Most commonly used synonyms for lipedema include:
- Adiposalgia/Adipoalgesia
- Adiposis dolorosa
- Lipalgia
- Lipomatosis dolorosa of the legs
- Lipodystrophia dolorosa
- Painful column leg
This condition almost exclusively affects women; according to an epidemiologic study by Földi E. and Földi M.(2),
lipedema affects 11% of the female population, and literature suggests that
lipedema is associated with extensive hormonal disorders or liver dysfunctions
if present in males.
Lipedema is a painful fat disorder and if left untreated can cause multiple
secondary health problems, to include mobility issues and lymphedema. The
quality of life, emotionally and physically, for individuals affected by
lipedema is often decreased due to the fact that the condition is typically
dismissed as simple obesity by clinicians unfamiliar with the symptoms.
The underlying cause for the development of lipedema remains unknown; it is
thought to be associated with hormonal disorders and can be hereditary with 14%
of affected individuals having a family history of lipedema (3). Lipedema can
develop early in puberty; however, the mean age of diagnosis is approximately
35.
Lipedema can be diagnosed based on clinical criteria (history, typical
clinical features) and by physical examination rather than with diagnostic
tests.
Clinical Features:
- Symmetrical distribution of fat between the hips and ankles, the feet are not involved
- Ring of fatty tissue overlapping the tops of the feet
- Tissue has a soft rubber-like feel in early stages
- Initially, the skin color is normal
- Typical bulges of fatty tissue on the medial thigh (above the knee and close
to the groin) are seen in later stages
- Small fatty lumps (nodules) within the tissues start to form in later stages
- In the early stages of lipedema the upper part of the body may be slender
- Weight loss does not have an effect on the areas affected by lipedema
- Swelling (edema) is common in the second half of the day and includes the
feet, but decreases in the early stage with elevation and night-time rest
- Pain, tenderness, sensitivity to pressure
- Easy bruising
For the purpose of this forum, the additional swelling that develops in the
later hours of the day in lipedema is of particular interest and is indicative
for the involvement of the lymphatic system if lipedema remains without proper
management.
Corkscrew-like appearance of lymph collectors in
lipedema
The excessive amount of fatty tissue present in lipedema compresses the lymph
collectors of the superficial lymphatic system, which are embedded in the fatty
subcutaneous tissue. Lymphangiographic imaging shows that the lymph collectors
within the proliferated fatty tissue have a coiled or corkscrew-like appearance
rather than passing fairly straight towards the lymph nodes as is the case in
healthy tissue. This can result in a reduced transport capacity of the
lymphatic system in the affected area.
If the capacity of the lymphatic system is reduced to such an extent that it
becomes unable to perform one of its basic functions, the removal of water from
the tissues, fluid will accumulate and “real” edema develops in addition to
lipedema.
In the initial stages the swelling may recede with elevation and
rest, but over time and without adequate treatment (compression, elevation,
exercise), the constant strain on the lymphatic system may cause damage to the
lymphatic vessels, leading to further reduction of its transport capacity, and
swelling may be constantly present.
Lipo-lymphedema
As a result of prolonged overstrain of the lymphatic system, lymphedema may
develop secondary to lipedema (lipo-lymphedema), thereby increasing the
complexity of treatment. If lipo-lymphedema remains without treatment, it will
progress through the same stages as primary or secondary lymphedema.
Treatment
Active treatment for lipedema is necessary because early diagnosis and
treatment can determine the individual’s long-term prognosis. Therapy for
lipedema can be largely divided into conservative treatments to reduce edema,
and surgical treatments such as liposuction.
Main goals in the conservative
treatment of lipedema are to decrease pain and hypersensitivity, increase
mobility and to prevent, or if already present, to address the edematous
component associated with lipedema. If lipedema, or lipo-lymphedema is
associated with obesity, nutritional guidance must be provided to reduce weight
and avoid further weight gain.
Conservative approaches include complete decongestive therapy (CDT); CDT does not
address proliferated fatty tissue, but contributes to the reduction of edema
and the prevention of the manifestation of lipo-lymphedema. The various
components of CDT also contribute to reducing pain and hypersensitivity to
pressure.
In most cases it is necessary to apply a lower level of
compression (bandages and compression garments) due to pain and
hypersensitivity in the affected areas. Compression garments generally have to
be custom-made to the individuals’ measurements. If the use of compression
garments is discontinued, edema will return.
Surgical treatment may be considered for patients with lipedema who do not
respond to conservative treatment. Liposuction is currently the standard
surgical treatment method; however, this procedure may cause bleeding and
secondary damage to lymph vessels resulting in persistent swelling. New and
more advanced techniques may reduce these risks; however, individuals
considering this approach should ensure that the performing physician is
experienced and follows internationally established guidelines.
Postoperatively, there is generally an increased tendency for swelling, thus
CDT should be initiated or continued within a few days of the procedure.
In the presence of additional lymphedema (lipo-lymphedema) the treatment
protocol for complete decongestive therapy corresponds with that for primary
lymphedema. CDT shows good long-term results in lipo-lymphedema; however
affected individuals need to understand that, although the lymphedemateous
component responds well and generally relatively fast to CDT, the lipedema
itself, i.e. the reduction of fatty tissue responds more slowly, and sometimes
not at all. According to several authors, reduction of the excessive fatty
tissue in lipedema is possible if compression garments are worn constantly.
(1) Herpertz, U. (1995) Das Lipödem. Lymphologie 19, 1-11
(2) Földi, E., and Földi, M. (2006) Lipedema. In Földi’s Textbook
ofLymphology (Földi, M., and Földi, E., eds) pp. 417-427, Elsevier
GmbH,Munich,Germany
(3) Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S, Mortimer
PS. Lipedema: an inherited condition. Am J Med Genet A. 2010;152A:970–976. [PubMed]
Additional Reading:
http://www.hanse-klinik.com/englisch/Lipoedema.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309375/