Lipedema—An update

Wollina, Uwe

doi:10.1111/dth.12805

Cited by 34 publications

(74 citation statements)

References 29 publications

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“…Lymphedema typically starts on the toes and then reaches the thighs, whereas in lipedema, usually thighs are affected first, the feet are spared and the fat deposits show a sharp demarcation above the ankles. Stemmer's sign, the inability to pinch the skin over the proximal phalanx of the second toe, is commonly present in lymphedema, on the contrary, is absent in pure lipedema 1,6,7 . The skin is thin and intact in lipedema, whereas it is often discolored, warty, and sclerotic in lymphedema 6 .…”

Section: Differential Diagnosismentioning

confidence: 99%

Cause and management of lipedema‐associated pain

Aksoy

Karadağ

Wollina

2020

Dermatologic Therapy

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Lipedema is a painful, underdiagnosed adipose tissue disorder, characterized by symmetrical swelling of the extremities due to subcutaneous fat deposition in the buttocks, thighs, legs, and arms, sparing the most distal part of the extremities. Although etiology and pathogenesis of lipedema is unclear, possible role of hormonal and genetic factors have been proposed previously. Patients with lipedema suffer from pain, easy bruising, tenderness, and disfigurement. Pain is the leading symptom in lipedema. Since the pain is associated with depression and impaired quality of life, reduction of pain is the major therapeutic approach. Pain in lipedema is attributed to allodynia, exaggerated sympathetic signaling, and estrogens. Although the mechanism of pain in lipedema is uncertain, effective treatment of lipedema should provide a satisfactory pain reduction. Efficacy of the conservative treatment is a matter of debate. Microcannular tumescent liposuction is the most effective therapeutic option for lipedema. There is a large body of evidence that this procedure significantly reduces pain in patients with lipedema.

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Section: Differential Diagnosismentioning

confidence: 99%

Cause and management of lipedema‐associated pain

Aksoy

Karadağ

Wollina

2020

Dermatologic Therapy

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“…The severity classification is based on a physical examination of the skin and subcutaneous tissue quality primarily through palpation (Figure 1). 10 …”

Section: Introductionmentioning

confidence: 99%

“…Current publications have described a large number of associated comorbidities for patients with lipedema 5,7,8,10 . A major topic of discussion is the high proportion of obesity in lipedema patients and its influence on therapy guidelines 9,26 .…”

Section: Introductionmentioning

confidence: 99%

“…9 The severity classification is based on a physical examination of the skin and subcutaneous tissue quality primarily through palpation (Figure 1). 10 The cause of the disease has not yet been clarified. Family clusters indicate a genetic component with a possibly x-chromosomal dominant inheritance pattern and incomplete penetrance.…”

mentioning

confidence: 99%

“…5 Current publications have described a large number of associated comorbidities for patients with lipedema. 5,7,8,10 A major topic of discussion is the high proportion of obesity in lipedema patients and its influence on therapy guidelines. 9,26 The widely postulated "diet resistance" of lipedema adipose tissue has so far not been substantiated with evidence.…”

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confidence: 99%

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Disease progression and comorbidities in lipedema patients: A 10‐year retrospective analysis

Ghods

Georgiou

Schmidt

et al. 2020

Dermatologic Therapy

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Multiple associated comorbidities have been described for lipedema patients. Disease diagnosis still remains challenging in many cases and is frequently delayed. The purpose of this study was to determine the most common comorbidities in lipedema patients and the impact of surgical treatment onto disease progression. A retrospective assessment of disease-related epidemiologic data was performed for patients who underwent liposuction between July 2009 and July 2019 in a specialized clinic for lipedema surgery. All patients received a standardized questionnaire regarding the clinical history and changes of lipedema-associated symptoms and comorbidities after surgery. 106 patients who underwent a total of 298 liposuction procedures were included in this study after returning the questionnaire fully filled-in. Multiple comorbidities were observed in the assessed collective. The prevalence for obesity, hypothyroidism, migraine, and depression were markedly increased in relation to comparable nonlipedema populations. Despite a median body mass index (BMI) of 31.6 kg/m 2 (IQR 26.4-38.8), unexpected low prevalence of diabetes (5%) and dyslipidemia (7%) was found. Diagnosis and initiation of guideline-appropriate treatment were delayed by years in many patients. After surgical treatment (medium follow-up 20 months, IQR 11-42), a significant reduction of lipedema-associated symptoms was demonstrated. Lipedema occurs with a diversity of associated comorbidities. Therefore, on the basis of available data, the authors suggest the necessity of a multimodal therapy concept for a comprehensive and holistic treatment. Despite a commonly increased BMI, lipedema patients appear to have an advantageous metabolic risk profile.

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