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.
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•
Georgetown University1, University of São Paulo2, University of California, San Diego3, Katholieke Universiteit Leuven4, Mayo Clinic5, George Washington University6, Flinders University7, St George's, University of London8, University of Bonn9, Stanford University10, The Catholic University of America11, University of Szeged12, Uniformed Services University of the Health Sciences13
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
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]....
[...]
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]....
[...]
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
Journal Article•
TL;DR: Complete decongestive physiotherapy significantly reduced capillary fragility in patients with lipedema and this reduction may lead to reduced hematoma formation.
Abstract: Lipedema is a disproportional obesity featuring frequent hematoma formation due to even minor traumatic injuries. On the basis of clinical observations, complete decongestive physiotherapy diminishes the incidence of hematomas due to minor injuries beyond leg volume reduction. Hematoma development may be caused by altered capillary resistance (CR) or altered capillary fragility (CF). We measured capillary fragility (CF) before and after complex decongestive physiotherapy (CDP) to examine, whether CDP could reduce CF. 38 women with lipedema were included in the study. Twenty-one (21) patients were treated with CDP and 17 using exclusively moisturizers as the control group. CDP comprised once daily manual lymph drainage, intermittent pneumatic compression and multilayered short-stretch bandaging performed throughout a 5-day-course. CF was evaluated with the vacuum suction method (VSM) using Parrot's angiosterrometer in both groups. Decongestive therapy resulted in a significant reduction of the number of petechiae while no change was detected within the control group. Complete decongestive physiotherapy significantly reduced CF in patients with lipedema and this reduction may lead to reduced hematoma formation.
57 citations
TL;DR: The background to NeLH in Information for Health is described, the aims, benefits and architecture of the proposed service are outlined and the challenge to Health librarians to develop new skills in informatics and critical appraisal is identified.
Abstract: The National eletronic Library for Health (NeLH) is to write a new knowledge service for patients and clinicians. This article describes the background to NeLH in Information for Health and outlines the aims, benefits and architecture of the proposed service. It identifies the challenge to Health librarians to develop new skills in informatics and critical appraisal.
52 citations
Journal Article•
TL;DR: The addition of IPC is safe, although it provides no synergistic benefit to CDP in leg volume reduction under these study conditions, and the addition of CDP alone or combined with intermittent pneumatic compression is safe.
Abstract: Lipedema is a disproportional obesity for which evidence-based treatment is not currently available. We studied whether complete decongestive physiotherapy (CDP) alone or combined with intermittent pneumatic compression (IPC) could improve the treatment outcome in women with lipedema using a prospective, randomized trial. Eleven patients received CDP (60 min) and thirteen CDP (30 min) plus IPC (30 min) once daily in a 5-day-course. Subsequent to drainage, all subjects received multilayered compression bandaging, physical exercise and skin care. Treatment efficacy was evaluated by limb volume reduction. Both groups achieved significant reductions in mean lower extremity volume (p < 0.05). The addition of IPC is safe, although it provides no synergistic benefit to CDP in leg volume reduction under these study conditions.
46 citations
"Lipedema: an overview of its clinic..." refers methods in this paper
...Novel techniques as powerassisted liposuction with machine-powered 30–40 cm long and 3–4 mm wide metal cannulas oscillating in and out or vibrating fast using multiple insertions with limited amount of aspirated fat (53,55) or water jet-assisted liposuction have been shown to improve safety (57)....
[...]
TL;DR: Management of this condition is perceived by the consultants to be poor, with a lack of resources and particular shortage of lymphoedema physiotherapists, and centralisation of these services may be a way of improving this condition.
46 citations
TL;DR: A case of a patient with lipedema who was treated with suction-assisted lipectomy and use of compression garments, with successful treatment of the lipodystrophy and maintenance of improved aesthetic results at 4-year postoperative follow-up is reported.
Abstract: Lipedema is a condition characterized by abnormal deposition of adipose tissue in the lower extremities leading to circumferential bilateral lower extremity enlargement typically seen extending from the hips to the ankles. Diagnosis of the condition is often challenging, and patients frequently undergo a variety of unsuccessful therapies before receiving the proper diagnosis and appropriate management. Patients may experience pain and aching in the lower extremity in addition to distress from the cosmetic appearance of their legs and the resistance of the fatty changes to diet and exercise. We report a case of a patient with lipedema who was treated with suction-assisted lipectomy and use of compression garments, with successful treatment of the lipodystrophy and maintenance of improved aesthetic results at 4-year postoperative follow-up.
45 citations
"Lipedema: an overview of its clinic..." refers background in this paper
...Recent reports show the long-term efficacy of liposuction in maintaining the volume of the limb (60), emphasizing the use of compression garment 24 h per day after the procedure (61); however, conservative decongestion could be either stopped or its frequency could be substantially decreased (55)....
[...]