scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Lipedema: an overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review.

TL;DR: Early diagnosis and treatment are mandatory for this disorder otherwise gradual enlargement of fatty deposition causes impaired mobility and further comorbidities like arthrosis and lymphatic insufficiency.
Abstract: Lipedema is a disproportionate, symmetrical fatty swelling characterized by pain and bruising existing almost exclusively among women. We undertook a systematic review of the available literature about lipedema, given the lack of knowledge and little evidence about this disorder especially among obesity experts. Diagnosis of lipedema is usually based on clinical features. Symmetrical edema in the lower limbs with fatty deposits located to hips and thighs usually appears at puberty and often affects several members of the same family. Main disorders considered for differential diagnosis are lymphedema, obesity, lipohypertrophy and phlebedema. Treatment protocols comprise conservative (decongestive lymphatic therapy) and surgical (liposuction) approaches. Early diagnosis and treatment are mandatory for this disorder otherwise gradual enlargement of fatty deposition causes impaired mobility and further comorbidities like arthrosis and lymphatic insufficiency.

Content maybe subject to copyright    Report

Citations
More filters
01 Aug 2011
TL;DR: The use of “red flags” to guide decisions about the need for further investigation of suspected vertebral fracture in patients presenting with low-back pain is unfounded, and an updated review provides mixed relief for people with diabetes suffering from foot ulcers.
Abstract: The use of “red flags” (specific information from the clinical history and examination used as sentinels of disease) to guide decisions about the need for further investigation of suspected vertebral fracture in patients presenting with low-back pain is unfounded. That’s the discouraging conclusion of the latest diagnostic test accuracy review. The authors looked at eight studies and found that many red flags have high falsepositive rates. The limited evidence makes recommending specific red flags a challenge, but three (older age, significant trauma and corticosteroid use) were more promising, and combinations of red flags were more informative than individual tests (doi: 10.1002/14651858.CD008643.pub2). The primary prevention of cardiovascular disease comes under the spotlight in one new and one updated review. Selenium supplementation is aggressively marketed in some quarters, but the evidence from a new review of 12 studies involving nearly 20 000 participants does not support its use, especially in populations with adequate selenium status. Furthermore, the authors are cautious not to rule out the possibility of an increased risk of type 2 diabetes from taking selenium-only supplements (doi: 10.1002/14651858.CD009671. pub2). More definitive is the evidence to support the use of statins in people at low risk of cardiovascular disease. This comes from an updated review that now includes data on 57 000 participants from 18 randomised trials. Statins reduced major vascular events as well as all-cause mortality. Added bonuses were the absence of serious harms and the likelihood that statins are cost-effective (doi: 10.1002/14651858.CD004816.pub5). An updated review provides mixed relief for people with diabetes suffering from foot ulcers. Non-removable, pressure-relieving casts heal ulcers more effectively than removable casts or dressings alone, but this comes at the price of restricted movement and a possible decrease in quality of life (doi: 10.1002/14651858.CD002302.pub2). Hiccups are a passing nuisance for most of us, but spare a thought for the few who suffer from persistent or intractable hiccups (defined as lasting for more than 48 hours and more than 1 month, respectively). Unfortunately, there’s little relief in sight, since the four poor-quality trials reviewed all investigated treatment with acupuncture and showed that it may be no better than placebo (doi: 10.1002/14651858.CD008768.pub2). Find these and other new and updated reviews this month in The Cochrane Library at www.thecochranelibrary.com. From The Cochrane Library

123 citations

Journal Article
TL;DR: Treatment in the maintenance phase should include compression garments, self-management, including self-massage, meticulous personal hygiene and skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression therapy applied in the home.
Abstract: Primary lymphedema can be managed effectively as a form of chronic lymphedema by a sequenced and targeted treatment and management program based around a combination of Decongestive Lymphatic Therapy (DLT) with compression therapy, when the latter is desired as an adjunct to DLT. Treatment in the maintenance phase should include compression garments, self-management, including self-massage, meticulous personal hygiene and skin care, in addition to lymphtransport-promoting excercises and activities, and, if desired, pneumatic compression therapy applied in the home. When conservative treatment fails, or gives sub-optimal outcomes, the management of primary lymphedema can be improved, where appropriate, with the proper addition of surgical interventions, either reconstructive or ablative. These two surgical therapies can be more effective when fully integrated with manual lymphatic drainage (MLD)-based DLT postoperatively. Compliance with a long-term commitment to MLD/DLT and particularly compression postoperatively is a critical factor in determining the success of any new treatment strategy involving either reconstructive or palliative surgery. The future of management of primary lymphedema has never been brighter with the new prospect of gene-and perhaps stem-cell oriented management.

103 citations

Journal ArticleDOI
TL;DR: According to the hypothesis, lipedema is an estrogen-regulated polygenetic disease, which manifests in parallel with feminine hormonal changes and leads to vasculo- and lymphangiopathy and is likely to be a secondary phenomenon maintaining a vicious cycle.

76 citations


Cites background from "Lipedema: an overview of its clinic..."

  • ...Decongestive lymphatic therapy including manual lymphatic drainage, physical exercise, multilayered and multicomponent compression bandaging and meticulous skin care is the standard conservative approach for lipedema treatment [5]....

    [...]

  • ...8% of the patients in their unit with enlargement of the lower limbs between 2005 and 2012 [5]....

    [...]

Journal ArticleDOI
TL;DR: Ledema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema, and more controlled studies are needed to study the mechanisms and treatments for lipedema.
Abstract: Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.

66 citations


Additional excerpts

  • ...8% in their patients [1], [11], [12], [13], [14], [15], [16], [17]....

    [...]

Journal ArticleDOI
TL;DR: The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP) and contain recommendations with respect to diagnosis and management oflipedema.
Abstract: Summary The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. Surgical procedures are indicated if – despite thorough conservative treatment – symptoms persist, or if there is progression of clinical findings and/or symptoms. If present, morbid obesity should be therapeutically addressed prior to liposuction.

66 citations

References
More filters
01 Jan 1988
TL;DR: It is proposed that the chapters on external causes of injury and poisoning, and factors influencing health status and contact with health services, should form an integral part of ICD-10, for the first time in its history based on an alphanumeric coding scheme.
Abstract: The International Classification of Diseases has, under various names, been for many decades the essential tool for national and international comparability in public health. This statistical tool has been customarily revised every 10 years in order to keep up with the advances of medicine. At first intended primarily for the classification of causes of death, its scope has been progressively widening to include coding and tabulation of causes of morbidity as well as medical record indexing and retrieval. The ability to exchange comparable data from region to region and from country to country, to allow comparison from one population to another and to permit study of diseases over long periods, is one of the strengths of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD). WHO has been responsible for the organization, coordination and execution of activities related to ICD since 1948 (Sixth Revision of the ICD) and is now proceeding with the Tenth Revision. For the first time in its history the ICD will be based on an alphanumeric coding scheme and will have to function as a core classification from which a series of modules can be derived, each reaching a different degree of specificity and adapted to a particular specialty or type of user. It is proposed that the chapters on external causes of injury and poisoning, and factors influencing health status and contact with health services, which were supplementary classifications in ICD-9, should form an integral part of ICD-10. The title of ICD has been amended to "International Statistical Classification of Diseases and Related Health Problems"', but the abbreviation "ICD" will be retained.(ABSTRACT TRUNCATED AT 250 WORDS)

2,084 citations

Journal Article
TL;DR: It is shown that whilst good evidence for the use of compression is available in some clinical indications, there is much still to be discovered.
Abstract: Aim The aim of this study was to review published literature concerning the use of compression treatments in the management of venous and lymphatic diseases and establish where reliable evidence exists to justify the use of medical compression and where further research is required to address areas of uncertainty. Methods The authors searched medical literature databases and reviewed their own collections of papers, monographs and books for papers providing information about the effects of compression and randomized clinical trials of compression devices. Papers were classified in accordance with the recommendations of the GRADE group to categorize their scientific reliability. Further classification was made according to the particular clinical problem that was addressed in the papers. The review included papers on compression stockings, bandages and intermittent pneumatic compression devices. Results The International Compression Club met once in Vienna and corresponded by email in order to reach an agreement of how the data should be interpreted. A wide range of compression levels was reported to be effective. Low levels of compression 10-30 mmHg applied by stockings are effective in the management of telangiectases after sclerotherapy, varicose veins in pregnancy, the prevention of edema and deep vein thrombosis (DVT). High levels of compression produced by bandaging and strong compression stockings (30-40 mmHg) are effective at healing leg ulcers and preventing progression of post-thrombotic syndrome as well as in the management of lymphedema. In some areas no reliable evidence was available to permit recommendations of level of compression or duration of treatment. These included: management of varicose veins to prevent progression, following surgical treatment or sclerotherapy for varicose veins, and the level of compression required to treat acute DVT. Conclusion This review shows that whilst good evidence for the use of compression is available in some clinical indications, there is much still to be discovered. Little is know about dosimetry in compression, for how long and at what level compression should be applied. The differing effects of elastic and short-stretch compression are also little understood.

231 citations

Journal ArticleDOI
TL;DR: The common differential diagnosis in Western patients with lower limb swelling is secondary lymphedema, venous disease, lipedema, and adverse reaction to ipsilateral limb surgery.
Abstract: Hypothesis The causes and management of lower limb lymphedema in the Western population are different from those in the developing world. Objective To look at the differential diagnosis, methods of investigation, and available treatments for lower limb lymphedema in the West. Data Source A PubMed search was conducted for the years 1980-2002 with the keyword "lymphedema." English language and human subject abstracts only were analyzed, and only those articles dealing with lower limb lymphedema were further reviewed. Other articles were extracted from cross-referencing. Results Four hundred twenty-five review articles pertaining to lymphedema were initially examined. This review summarizes the findings of relevant articles along with our own practice regarding the management of lymphedema. Conclusions The common differential diagnosis in Western patients with lower limb swelling is secondary lymphedema, venous disease, lipedema, and adverse reaction to ipsilateral limb surgery. Lymphedema can be confirmed by a lymphoscintigram, computed tomography, magnetic resonance imaging, or ultrasound. The lymphatic anatomy is demonstrated with lymphoscintigraphy, which is particularly indicated if surgical intervention is being considered. The treatment of choice for lymphedema is multidisciplinary. In the first instance, combined physical therapy should be commenced (complete decongestive therapy), with surgery reserved for a small number of cases.

219 citations

Journal ArticleDOI
TL;DR: It is proposed that lipedema is a genetic condition with either X‐linked dominant inheritance or more likely, autosomal dominant inheritance with sex limitation, and appears to be a condition almost exclusively affecting females, presumably estrogen‐requiring as it usually manifests at puberty.
Abstract: Lipedema is a condition characterized by swelling and enlargement of the lower limbs due to abnormal deposition of subcutaneous fat. Lipedema is an under-recognized condition, often misdiagnosed as lymphedema or dismissed as simple obesity. We present a series of pedigrees and propose that lipedema is a genetic condition with either X-linked dominant inheritance or more likely, autosomal dominant inheritance with sex limitation. Lipedema appears to be a condition almost exclusively affecting females, presumably estrogen-requiring as it usually manifests at puberty. Lipedema is an entity distinct from obesity, but may be wrongly diagnosed as primary obesity, due to clinical overlap. The phenotype suggests a condition distinct from obesity and associated with pain, tenderness, and easy bruising in affected areas.

169 citations


"Lipedema: an overview of its clinic..." refers background in this paper

  • ...These strong familial background suggests that lipedema is a genetic disorder (22)....

    [...]

  • ...have recently found a Pit-1 mutation in members of a family with lipedema (47) and screening of lipedema family members strongly suggests inheritance (22)....

    [...]