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.

Liposuction reduces the symptoms of lipedema significantly.

Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range.

DefinitionSchwitzen ist ein physiologischer, lebensnotwendiger Prozess, bei dem aus den ekkrinen Schweißdrüsen ein wässriges Sekret abgegeben wird. Durch die rasche Verdunstung des Schweißes wird dem Körper Wärme entzogen, so dass der Organismus vor Überhitzung geschützt wird. Die hierzu erforderliche Schweißmenge kann mehrere Liter pro Tag erreichen. Im Gegensatz dazu bezeichnet der Begriff Hyperhidrose, ein Übermaß an Schwitzen, welches über die Erfordernisse der Wärmeregulation hinausgeht. Hyperhidrose wird daher nicht anhand der Schweißmenge, sondern aufgrund der Fehlfunktion des Schwitzens definiert. Diese Fehlfunktion kann zu erheblichen sozialen und beruflichen Einschränkungen führen und damit eine ausgeprägte Verminderung der Lebensqualität hervorrufen.

BACKGROUND Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that usually affects the lower extremities of women. Also known as “two-body syndrome,” the fat accumulations in lipedema are unsightly and painful. The disorder is well-known in Europe but is largely unrecognized and underdiagnosed in the United States. OBJECTIVE To hold the First International Consensus Conference on Lipedema with the purpose of reviewing current European guidelines and the literature regarding the long-term benefits that have been reported to occur after lymph-sparing liposuction for lipedema using tumescent local anesthesia. METHODS International experts on liposuction for lipedema were convened as part of the First International Congress on Lipedema in Vienna, Austria, June 9 to 10, 2017. RESULTS Multiple studies from Germany have reported long-term benefits for as long as 8 years after liposuction for lipedema using tumescent local anesthesia. CONCLUSION Lymph-sparing liposuction using tumescent local anesthesia is currently the only effective treatment for lipedema.