Q: I recently had a patient with Lipedema. I have never heard of this condition. Is it similar to lymphedema?
Lipedema is a chronic medical condition characterized by a symmetrical buildup of adipose tissue in the legs and arms, but not the hands or feet. It is not the same as obesity, in which fat occurs throughout the body. It is often confused with lymphedema, which typically occurs on just one side of the body and includes the hands and feet. It should also not be confused with lipidemia, which is the presence of lipids in the blood. Lipedema is seen almost exclusively in women (Lipedema Foundation, n.d.). It is an underdiagnosed and underrecognized disorder. The incidence is not completely known but it is estimated to affect approximately 11% of the female population (Roxbury Institute, n.d.). The disease affects body image, self-esteem, and quality of life due to disfigurement. Confusion with obesity and lymphedema can delay diagnosis.
The cause is not well known or understood. It starts or becomes worse in puberty, pregnancy, and menopause. Although obesity does not cause lipedema, a literature review by Czerwinska et al. (2021) found that there may be a connection between lipedema and obesity because in a few studies, persons with lipedema were overweight.
Lipedema is diagnosed through medical history and physical exam. A lack of understanding of the disease often results in misdiagnosis. Upon physical exam, skin with lipedema has a texture that feels like rice, peas, or walnuts beneath the surface of the skin. Some people have intermittent pain whereas others do not. Some only feel pain with palpation. The pain is described as dull, heavy, pressing (Aksoy et al., 2021). In addition to pain, lipedema can cause swelling and easy bruising.
The goals of treatment are:
* Improve lymphatic flow
* Exercise such as swimming, walking, and pilates that may decrease pain
* Reduction in inflammation by adhering to an anti-inflammatory diet: avoiding simple starches, sugars, refined foods, and saturated and trans fats. Fruits/vegetables; plants in the allium family such as garlic, onions, scallions, and leeks should be included in the diet. Beans (all types) are also anti-inflammatory. Healthy fats include extra virgin olive oil, avocados, and full-fat yogurt. Fish such as sardines, mackerel, and lake trout can decrease inflammation as well.
* Emotional support due to disfigurement and low self-esteem.
Diuretics, support stockings, and elevation of the extremities do not help. The only treatment currently is MicroCannular Tumescent Liposuction that also decreases pain (Aksoy et al., 2021). The Lipedema Foundation at http://www.lipedema.org/resources is a helpful resource.
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