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.
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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]....
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...8% of the patients in their unit with enlargement of the lower limbs between 2005 and 2012 [5]....
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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]....
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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
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22 citations
"Lipedema: an overview of its clinic..." refers background in this paper
...The search in the databases of clinical practice guidelines such as the National Guideline Clearinghouse (5), Guidelines Finder of the National electronic Library for Health of the NHS (6), CMA Infobase (7), CDR databases (8) and ACP Journal Club (9) did not bring any document....
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TL;DR: Aufgrund der vorliegenden Ergebnisse ist die Liposuktion bei Patientinnen mit Lipodem als ausgesprochen erfolgreich anzusehen eine ausgepragte Verbesserung des Aussehens mit Normalisierung der Korperproportionen.
Abstract: Die Liposuktion in Tumeszenz-Lokalanasthesie (TLA) mit vibrierenden Mikrokanulen (power assisted liposuction, PAL) hat sich zur Behandlung des Lipodems als effektives und nebenwirkungsarmes Verfahren erwiesen. Eigene Erfahrungen mit bisher 11 Patienten zeigten eine ausgepragte Verbesserung des Aussehens mit Normalisierung der Korperproportionen; zusatzlich kam es bei allen Operierten zum Verschwinden der Schmerzen und teilweise auch der Hamatomneigung. In fruheren Publikationen aufgefuhrte Komplikationen in Form von Lymphgefasschadigungen mit Odemverschlimmerung wurden nicht beobachtet. Aufgrund der vorliegenden Ergebnisse ist die Liposuktion bei Patientinnen mit Lipodem als ausgesprochen erfolgreich anzusehen.
20 citations
"Lipedema: an overview of its clinic..." refers background in this paper
...Besides heavy decongestion, liposuction drastically improves pain perception, mobility and range of motion, especially at knee joints and results appear to be sustained (58,59)....
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TL;DR: An insgesamt 100 Patienten einer phlebologischen Praxis sollten die Kriterien bei der sonographischen Diagnostik des Lymph- and Lipodems, auch in der Abgrenzung zum Phlebodem, weiterentwickelt werden, gezeigt werde, dass zusatzlich zur spezifischen »Sonomorphologie«
Abstract: An insgesamt 100 Patienten einer phlebologischen Praxis sollten die Kriterien bei der sonographischen Diagnostik des Lymph- und Lipodems, auch in der Abgrenzung zum Phlebodem, weiterentwickelt werden. Dabei konnte gezeigt werden, dass zusatzlich zur spezifischen »Sonomorphologie« des Lip- und Lymphodems die Kompressionssonographie ein unterschiedliches Verhalten bei schmerzhaftem und nicht schmerzhaftem Lipodem aufweist. Voraussetzung ist eine exaktere Abgrenzung von Kutis und Subkutis mit einem neuen 13-MHz-Schallkopf. Das schmerzhafte Lipodem erlaubt eine Kompression des verdickten und homogen vermehrt echogenen Subkutanbereichs um nur maximal 10 bis 20%, wogegen beim nicht schmerzhaften Lipodem eine Kompression um bis zu ca. 50% moglich ist. Die fur das Lymphodem typischen echolosen Spalten im Subkutanbereich zeigten keine Farbkodierung und erwiesen sich als ebenfalls nicht komprimierbar. Besonders wegen des geringen Zeitaufwands, der Nichtinvasivitat des Verfahrens und der fehlenden Strahlenbelastung ist die sonographische Darstellung, Vermessung und Kompression des Subkutanbereichs an einer definierten Stelle des Unterschenkels zur Diagnose, objektiven Kontrolle des Verlaufs, Uberprufung der Wirkung von Therapiemasnahmen und Zuordnung zur klinischen Symptomatik – letzteres speziell beim Lipodem – geeignet und der rein klinischen Untersuchung uberlegen.
19 citations
TL;DR: La lymphographie directe ou lymphangiographie est la seule technique anatomique capable of donner avec precision des renseignements sur la vascularisation lymphatique et la structure ganglionnaire a son origine and peut etre utile pour apprecier l'etat lymph atique a differents niveaux d'un membre.
Abstract: Methods for lymphatic imaging are numerous and can be roughly classified as anatomic or functional studies. Direct or indirect lymphographies provide useful informations in case of lymphostasis. Contrast lymphangiography is the only anatomical method giving precise informations either on lymphatic ducts or lymph nodes. Nevertheless this invasive method is no more indicated in cases of limb edemas. Indirect lymphographies study the spontaneous lymphatic drainage of inert particles injected into the dermis. The blue dye test is the most simple and the oldest indirect lymphography used in the positive diagnosis of a lymphostasis. It has been replaced with the indirect radionuclide lymphography which give more reliable informations. Fluorescence microlymphoangiography is an atraumatic method which permits the visualization of skin lymphatics. Indirect lymphangiography with contrast medium give reliable informations on the status of the initial lymphatics and is the best imaging method to differentiate between lipedema and lymphedema. Indirect radionuclide lymphoscintigraphy is a safe, non invasive and physiological method for the assessment of the limb lymphatic system used for morphological studies and objective measurement of the peripheral lymphatic function necessary to assess the lymphatic variation under therapy (decongestive physiotherapy, surgery, drugs).
17 citations
TL;DR: Subcutaneous panniculitis-like T-cell lymphoma: a clinicopathologic, immunophenotypic, and molecular study of 22 Asian cases according to WHO–EORTC classification.
Abstract: mas. Br J Haematol 2005; 128:333–42. 7 Jaffe ES, Gaulard P, Ralfkiaer E et al. Subcutaneous panniculitis-like T-cell lymphoma. In: WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue (Swerdlow SH, Campo E, Harris NL et al., eds), 4th edn. Geneva: WHO, 2008; 294–5. 8 Kong YY, Dai B, Kong JC et al. Subcutaneous panniculitis-like T-cell lymphoma: a clinicopathologic, immunophenotypic, and molecular study of 22 Asian cases according to WHO–EORTC classification. Am J Surg Pathol 2008; 32:1495–502. 9 Gafter-Gvili A, Sredni B, Gal R et al. Cyclosporin A-induced hair growth in mice is associated with inhibition of calcineurin-dependent activation of NFAT in follicular keratinocytes. Am J Physiol Cell Physiol 2003; 284:C1593–603.
16 citations