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Vol 24, No 4 (2018)
Review paper
Published online: 2018-12-30

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Lipedema: a clinical entity

Paweł Łyszczak12, Andrzej Szuba12
Acta Angiologica 2018;24(4):141-148.


Lipedema is a chronic, progressive disorder of adipose tissue, found almost exclusively in women, that involves
disproportionate subcutaneous fat depositions, leading to progressive and symmetric enlargement of the legs.
The condition usually appears at puberty or in the third decade of life. Many patients report a family history of
such disorder. The diagnosis is usually based on the physical examination and medical history. If left untreated,
lipedema may result in secondary lymphatic dysfunction, physical impairment and mental problems, leading
to significant damage to patient’s quality of life. The condition is frequently misdiagnosed as lymphedema or
mistreated as obesity. Other than that, the differential diagnosis includes chronic venous insufficiency, constitutional
variability of the legs, lipohypertrophy, Dercum’s disease, Madelung’s disease. The treatment options
include diet and compression therapy, conservative treatment of secondary edema and surgical interventions.
There is an urgent need for further studies on the pathogenesis of lipedema, epidemiology, diagnostic criteria
and possible curative treatment.

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  1. Allen E, Hines EJ. Lipedema of the legs. A syndrome characterized by fat legs and orthostatic edema. Proc Staff Meet Mayo Clin. 1940; 15: 184–187.
  2. WOLD LE, HINES EA, ALLEN EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med. 1951; 34(5): 1243–1250.
  3. Herbst KL. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin. 2012; 33(2): 155–172.
  4. Langendoen SI, Habbema L, Nijsten TEC, et al. Lipoedema: from clinical presentation to therapy. A review of the literature. Br J Dermatol. 2009; 161(5): 980–986.
  5. Gregl A. Das lipödem. Z Lymphol. 1987; 11: 41–3.
  6. Herpetz U. Das lipödem. Z Lymphol. 1995; 19: 1–11.
  7. Cohen GM, Irby MB, Boles K, et al. Telemedicine and paediatric obesity treatment: review of the literature and lessons learnt. Clinical Obesity. 2012; 2(3-4): 103–111.
  8. Fonder MA, Loveless JW, Lazarus GS. Lipedema, a frequently unrecognized problem. J Am Acad Dermatol. 2007; 57(2 Suppl): S1–S3.
  9. Chen SG, Hsu SD, Chen TM, et al. Painful fat syndrome in a male patient. Br J Plast Surg. 2004; 57(3): 282–286.
  10. Fife CE, Maus EA, Carter MJ. Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Adv Skin Wound Care. 2010; 23(2): 81–92; quiz 93.
  11. Halk AB, Damstra RJ. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. Phlebology. 2017; 32(3): 152–159.
  12. Földi E, Földi M. Strössenreuther R, Kubik S. Textbook of lymphology for physicians and lymphedema therapists. 2nd ed. URBAN & FISCHER, Munchen 2006: 396–403.
  13. Brauer WJ, Brauer VS. Age-dependent lymph transport in legs of patients with lipedema | Altersabhängigkeit des lymphtransportes beim lipödem und lipolymphödem. Lymphologie Forsch und Prax. 2005; 9(1).
  14. Amann-Vesti BR, Franzeck UK, Bollinger A. Microlymphatic aneurysms in patients with lipedema. Lymphology . 2001; 34(4): 170–175.
  15. Harvey NL, Srinivasan RS, Dillard ME, et al. Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity. Nat Genet. 2005; 37(10): 1072–1081.
  16. Nougues J, Reyne Y, Dulor JP. Differentiation of rabbit adipocyte precursors in primary culture. Int J Obes. 1988; 12(4): 321–333.
  17. Siems W, Grune T, Voss P, et al. Anti-fibrosclerotic effects of shock wave therapy in lipedema and cellulite. Biofactors. 2005; 24(1-4): 275–282.
  18. Suga H, Araki J, Aoi N, et al. Adipose tissue remodeling in lipedema: adipocyte death and concurrent regeneration. J Cutan Pathol. 2009; 36(12): 1293–1298.
  19. Child AH, Gordon KD, Sharpe P, et al. Lipedema: an inherited condition. Am J Med Genet A. 2010; 152A(4): 970–976.
  20. Bano G, Mansour S, Brice G, et al. Pit-1 mutation and lipoedema in a family. Exp Clin Endocrinol Diabetes. 2010; 118(6): 377–380.
  21. Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016; 8: 389–395.
  22. Stutz JJ, Krahl D. Water jet-assisted liposuction for patients with lipoedema: histologic and immunohistologic analysis of the aspirates of 30 lipoedema patients. Aesthetic Plast Surg. 2009; 33(2): 153–162.
  23. Vignes S. [Lipedema: a misdiagnosed entity]. J Mal Vasc. 2012; 37(4): 213–218.
  24. Schmeller W, Meier-Vollrath I. Lipödem. Gefässchirurgie. 2009; 14(6): 516–522.
  25. Meier-Vollrath I, Schmeller W. Lipoedema - current status, new perspectives. J Dtsch Dermatol Ges. 2004; 2(3): 181–186.
  26. Fife C, Carter M. Lymphoedema in bariatric patients. J Lymphoedema. 2009; 4(2): 29.
  27. Naouri M, Samimi M, Atlan M, et al. High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema. Br J Dermatol. 2010; 163(2): 296–301.
  28. Monnin-Delhom ED, Gallix BP, Achard C, et al. High resolution unenhanced computed tomography in patients with swollen legs. Lymphology. 2002; 35(3): 121–128.
  29. Dimakakos PB, Stefanopoulos T, Antoniades P, et al. MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. Int Surg. 1997; 82(4): 411–416.
  30. Duewell S, Hagspiel KD, Zuber J, et al. Swollen lower extremity: role of MR imaging. Radiology. 1992; 184(1): 227–231.
  31. Lohrmann C, Foeldi E, Langer M. MR imaging of the lymphatic system in patients with lipedema and lipo-lymphedema. Microvasc Res. 2009; 77(3): 335–339.
  32. Harwood CA, Bull RH, Evans J, et al. Lymphatic and venous function in lipoedema. Br J Dermatol. 1996; 134(1): 1–6.
  33. Van Geest AJ, Esten , Cambier J, et al. Lymphatic disturbances in lipoedema. Phlebologie. 2003; 32(6): 138–142.
  34. Boursier V, Pecking A, Vignes S. [Comparative analysis of lymphoscintigraphy between lipedema and lower limb lymphedema]. J Mal Vasc. 2004; 29(5): 257–261.
  35. Bilancini S, Lucchi M, Tucci S, et al. Functional lymphatic alterations in patients suffering from lipedema. Angiology. 1995; 46(4): 333–339.
  36. Rasmussen JC, Herbst KL, Aldrich MB, et al. An abnormal lymphatic phenotype is associated with subcutaneous adipose tissue deposits in Dercum's disease. Obesity (Silver Spring). 2014; 22(10): 2186–2192.
  37. Beesley V, Janda M, Eakin E, et al. Lymphedema after gynecological cancer treatment : prevalence, correlates, and supportive care needs. Cancer. 2007; 109(12): 2607–2614.
  38. Stemmer R. Stemmer's sign - possibilities and limits of clinical diagnosis of lymphedema. Wien Med Wochenschr. 1999; 149(2-4): 85–86.
  39. Foldi E. The Stemmer sign | Uber das Stemmersche Zeichen. Vasomed. 1997; 9(3).
  40. Warren AG, Janz BA, Borud LJ, et al. Evaluation and management of the fat leg syndrome. Plast Reconstr Surg. 2007; 119(1): 9e–915e.
  41. Drozdz K, Chachaj A, Szuba A. The decongestive lymphatic therapy in the massive primary lower limb lymphedema treatment. Acta Angiologica. 2017; 23(3): 130–134.
  42. Ochałek K. The role of compression therapy in venous-lymphatic disturbances. Acta Angiol. 2012; 18(4): 168–76.
  43. Herpertz U. Range of lipedema at a special clinic for lymphological diseases: Manifestations, combinations and treatment possibilities | Krankheitsspektrum des Lipodems an einer Lymphologischen Fachklinik - Erscheinungsformen, Mischbilder und Behandlungsmoglichkeiten. Vasomed. 1997; 9(5).
  44. Müssig K, Gallwitz B. Lipohypertrophy. Dtsch Med Wochenschr. 2006; 131(33): 1807–1808.
  45. Reich-Schupke S, Altmeyer P, Stücker M. Thick legs - not always lipedema. J Dtsch Dermatol Ges. 2013; 11(3): 225–233.
  46. Yeh NC, Yang CY, Chou CW, et al. Madelung's disease. J Clin Endocrinol Metab. 2012; 97(9): 3012–3013.
  47. González-García R, Rodríguez-Campo FJ, Sastre-Pérez J, et al. Benign symmetric lipomatosis (Madelung’s disease): case reports and current management. Aesthetic Plast Surg. 2004; 28(2): 108–112.
  48. S. B, M. W, A. L, Y. S. Adiposis dolorosa (Dercum’s disease): 10-year follow-up. Ann Plastic Surg. 1994; 33: 664–668 .
  49. Herbst K, Asare-Bediako S. Adiposis dolorosa is more than painful fat. The Endocrinologist. 2007; 17(6): 326–334.
  50. Amine B, Leguilchard F, Benhamou C. Dercum’s disease (adiposis dolorosa): a new case-report. Joint Bone Spine. 2004; 71(2): 147–149.
  51. Beltran K, Herbst KL. Differentiating lipedema and Dercum's disease. Int J Obes (Lond). 2017; 41(2): 240–245.
  52. Campen R, Mankin H, Louis DN, et al. Familial occurrence of adiposis dolorosa. J Am Acad Dermatol. 2001; 44(1): 132–136.
  53. Hansson E, Svensson H, Brorson H. Review of Dercum's disease and proposal of diagnostic criteria, diagnostic methods, classification and management. Orphanet J Rare Dis. 2012; 7: 23.
  54. Garg A. Clinical review: lipodystrophies: genetic and acquired body fat disorders. J Clin Endocrinol Metab. 2011; 96(11): 3313–3325.
  55. Kurugöl Z, Ulger Z, Berk O, et al. Acquired partial lipodystrophy associated with varicella. Turk J Pediatr. 2009; 51(6): 617–620.
  56. Goodliffe JM, Ormerod JOM, Beale A, et al. An under-diagnosed cause of leg swelling. BMJ Case Rep. 2013; 2013.
  57. Fetzer A, Wise C. Living with lipoedema: reviewing different self-management techniques. Br J Community Nurs. 2015; Suppl Chronic: S14, S16–S14, S19.
  58. Fetzer A. Specialist approaches to managing lipoedema. Br J Community Nurs. 2016; Suppl: S30–S35.
  59. Wagner S. Lymphedema and lipedema - an overview of conservative treatment. Vasa. 2011; 40(4): 271–279.
  60. Szolnoky G, Nagy N, Kovács RK, et al. Complex decongestive physiotherapy decreases capillary fragility in lipedema. Lymphology. 2008; 41(4): 161–166.
  61. Szolnoky G, Varga E, Varga M, et al. Lymphedema treatment decreases pain intensity in lipedema. Lymphology . 2011; 44(4): 178–182.
  62. Tan IC, Maus EA, Rasmussen JC, et al. Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging. Arch Phys Med Rehabil. 2011; 92(5): 756–764.e1.
  63. Wienert V, Gerlach H, Gallenkemper G, et al. Leitlinie Medizinischer Kompressionsstrumpf (MKS). Phlebologie. 2018; 35(06): 315–320.
  64. Rapprich S, Dingler A, Podda M. Liposuction is an effective treatment for lipedema-results of a study with 25 patients. J Dtsch Dermatol Ges. 2011; 9(1): 33–40.
  65. Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012; 166(1): 161–168.
  66. Peled AW, Slavin SA, Brorson H. Long-term Outcome After Surgical Treatment of Lipedema. Ann Plast Surg. 2012; 68(3): 303–307.