Lipedema and Lymphedema

WHAT IS LIPEDEMA?

Lipedema is a genetically transmitted disorder.

Lipedema, which is also known as painful fat syndrome, is abnormal symmetrical swelling due to accumulations of fat and fluid located in the tissues just under the skin of the hips and legs. It extends downward toward the ankles but does not affect the feet. There are also fatty bulges on the outer surfaces of the thighs. [1]

• This condition is inherited, occurs almost exclusively in women, and most cases gradually develop during puberty.
• Lipedema involves the extra deposit and expansion of fat cells in a distinct pattern on the body from just below the waist to just above the ankles.
•  Unlike fat associated with obesity, the fat associated with lipedema cannot be exercised away.
• Also, this fat tissue does not respond to dieting or exercise.

THE SYMPTOMS OF LIPEDEMA

• In lipedema, pain is present particularly along the shin. This is a major problem for the patient.
• In the early stages of lipedema the upper part of the body may be slender.
• Despite having a slim upper body, fat accumulates from the tops of the hips to the ankles. 
• When weight is gained, it accumulates in the areas of the hips and legs.
• When weight is lost, the fat decrease occurs in areas other than those affected by lipedema. Weight loss does not occur in the area between the waist and ankles.
• Fat that extends down the legs creates a ring of fatty tissue that overlaps the tops of the feet.
• Swelling develops in the legs during the second half of the day; however, this swelling decreases during sleep.
• In the early stages, nodules develop. Nodules are small fatty lumps within the tissues.
• In the later stages, lobules develop. Lobules are rounded fat deposits that are larger than nodules.

THE STAGES OF LIPEDEMA

Stage 1 lipedema.

• In Stage I lipedema, the skin is still soft and regular, but nodular changes can be helt upon palpation. There are no color changes in the skin and the subcutaneous tissues have a spongy feel, like a soft rubber doll.
• In Stage II lipedema, the subcutaneous tissue become tougher and nodular. Large fatty lobules begin to form on the medial, distal, and proximal thigh and the medial and lateral ankles just above the ankle bones. Pitting edema is comm, increasing as the day progresses. The individual may report hypersensitivity over the skin area. Skin color changes occur in the lower leg, indicative of secondary lymphedema, which often occurs in later stage lipedema.

LIPEDEMA AND LYMPHEDEMA

While lipedema is not a disorder of the lymphatic system, lipedema and lymphedema are often confused because both conditions involve enlargement of the legs. Lipedema and lymphedema are distinctly different conditions; however, lipedema can cause secondary lymphedema to develop in the feet and the lower extremities to be present as a comorbidity. There are several features about lipedema that distinguish it from lower extremity lymphedema affecting both legs.

• Lymphedema is not symmetrical and often occurs in only one leg.
  Lipedema affects both legs with swelling that forms a characteristic ring at the base of the ankle where the swelling stops.
• Lymphedema symptoms do not include bruising and subcutaneous bleeding.

    Lipedema often causes bruising and subcutaneous bleeding (bleeding beneath the skin).

• Lymphedema has pitting edema as a diagnostic indicator

    Lipedema does not have pitting edema as a symptom.

• Lymphedema has Stemmer's sign as a diagnostic indicator.

    Lipedema does not have Stemmer's sign as a diagnostic indicator.

DIAGNOSTIC ERRORS 

Obesity due to gaining excess weight is a common complication of lipedema. As more weight is gained, additional stresses are placed on all of the body systems. However, diet is not the answer to the problem!

Although patients are told that they are fat and should loose weight, the fatty tissue of lipedema cannot be significantly decreased by diet. Obesity, caused by overeating, responds to a proper dietary regime: lipedema does not.

As the swelling progresses so that the ankles and feet are affected, often the assumption is that the patient has primary lipedema. This is not accurate, this swelling is due to secondary lymphedema that is damage the lymphatic flow due to the pressures caused by the limpedema. This is a co-mobidity known as lipo-lymphedema.

Lipo-lymphedema can also develop in combination with chronic venous insufficiency, idiopathic edema, and other vascular disorders.

THE TREATMENT OF LIPEDEMA 

At this time there is no effective treatment for lipedema. Evaluation by an endocrinologist, and the treatment of endocrine imbalances, may help. When lymphedema is also present, treating that condition can also help.

• Weight control, without drastic dieting, can help to prevent other conditions associated with obesity.
• Water exercises are helpful since the support of the water eases the strain on the joints. It is also relaxing and makes movements easier.

WHAT ABOUT LIPOSUCTION?

Liposuction is a surgical procedure to remove excessive fat from under the skin. Liposuction has been studied as a potential treatment of lipedema; however, it is not accepted for this purpose because of the risk that such surgery can make the condition worse. [3]

Although often perceived as being minor cosmetic surgery, this is not true of liposuction. It is an invasive procedure that cannot be performed without causing additional damage to the lymphatic system that can make the condition worse. When lymphedema is already present, there is also the increased risk of infection or poor healing after this surgery.

WHAT ABOUT GASTRIC BYPASS?

Gastric bypass surgery is performed to bring about the loss of body weight; however when this patient has lipedema, the weight will not be lost in the areas affected by that condition. When gross obesity is present, such surgery may be necessary; however, it is unrealistic to expect a reduction in the fatty areas of the hips and legs.

WHAT CAN HELP?

When lipedema and lymphedema are present concurrently (at the same time), the lymphedema therapist must balance the needs of both conditions.

• Because of the pain associated with lipedema, manual lymph drainage using only very light strokes is used initially. These gentle strokes open the superficial lymphatics, which are located just under the skin. This decreases the pain by clearing blocked drainage areas and clogged lymph nodes. After several sessions, when the pain is less, the therapist can begin working on the affected limbs.
• Bandaging and compression garments are not applied until the patient is able to tolerate this compression without pain. Some researchers believe that once the patient can tolerate compression, this may help to reduce the amount of fat that is present.

REFERENCES

[1] Lipedema Overview and Etiology www.lymphedema-therapy.com/Lipedema.htm

[2]  "Understanding Lipedema" by G. Klose and R. StröBenreuther. Lymph Link. Vol 19, No 1 January-March 2007, pages 1-3.

[3] "Lipedema" in The Lymphatic Continuum Revisited by S. G. Rockson ed.Annals of the New York Academy, Vol 1131 2008, page 165,

[4] Lipedema by Dr. Tony Reid

[5] Living Well with Lymphedema by A. Ehrlich, A. Vinjé-Harrewijn PT, CLT-LANA, and E. McMahon PhD. Lymph Notes, 2005, pages 86-89.

[6] Lymphedema, Lipedema, and the Open Wound: the role of compression therapy.” by J.M. Macdonald, et al. Surg Clin North Am. 2003 Jun;83(3):639-58.

[7] “What is lipedema?” by K.Thrift. Lymph Link Question Corner, Vol 19, No 1, January-March 2007.

[8] “Patient Perspective” by R. Morris. Lymph Link. Vol 19, No 1, January-March 2007, pages 24.

[9] Tilly Smidt on Lipedema

© LymphNotes.com 2011. This information does not replace the advice of a qualified professional.

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Category: Lymphedema and Other Conditions Updated: 2011-11-16