What is lipoedema?
Lipoedema (American spelling
lipedema) is characterised by abnormal fat deposition resulting in large legs that are greatly out of proportion to overall body size. It is often painful so may also be called
painful fat syndrome.
Lipoedema is nearly always seen in women. It develops soon after puberty and gradually progresses. The swelling affects the hips, thighs and the lower legs symmetrically, but feet are rarely affected. The fat often creates a ring of fatty tissue overlapping the top of the feet.
Overlying skin appears quite normal. The swelling does not pit on pressing it with a finger.
Although lipoedema tends to be worse in the overweight or obese, it may also affect women of normal weight. There is often a family history of the disorder.
It may be confused with lymphoedema, in which swelling is due to the accumulation of lymph, a protein-rich fluid. However, lymphoedema may develop within longstanding lipoedema (lipolymphoedema). This is recognised by the development of irregular lumps, and progression of swelling to involve the feet.
How is it diagnosed?
Lipoedema is diagnosed by its clinical features. It fails to improve on compression, if this is used following misdiagnosis of lymphoedema.
What is the treatment?
Treatment is generally unhelpful. It persists even when considerable weight is lost from other areas of the body with the help of dieting and exercise. Lipoedema is not affected by diuretics, elevation or compression. In fact, compression is usually intolerable because it aggravates the pain associated with lipoedema.
Lipectomy (surgery to cut out fat) or liposuction may be hazardous as they risk damaging the lymphatic vessels. However, tumescent liposuction has been reported to be a highly effective treatment for lipoedema with good morphological and functional long–term results.
- Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol 2011. Accepted manuscript online DOI 10.1111Accepted manuscript online: DOI: 10.1111/j.1365-2133.2011.10566.x
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