S1 guidelines: Lipedema

Abstract

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.

Lipoedema is not lymphoedema: A review of current literature

“…A positive family history suggesting lipoedema is linked to a genetic component has been described in up to 60% of cases . The overall prevalence of lipoedema in the general population is uncertain, and it has been reported to be as low as 0.1%; however, some studies conducted on outpatient's clinics estimate the prevalence to be 7% to 10% . Whereas studies conducted on hospitalised patients demonstrated prevalence percentages between 8% and 18% .…”

“…The typical presentation is of a woman with bilateral “stovepipe” enlargement of the legs and without involvement of the feet with a sharp demarcation between normal and abnormal tissue at the ankle, referred to as the “cuff sign.” This is often combined with a symmetrical involvement of arms, particularly the upper arms, with sparing of hands. Lipoedema may be isolated to the arms without involvement of the legs, but it is extremely rare . A characteristic feature of lipoedema is pain; it is described as dull, heavy, and pressing.…”

“…A characteristic feature of lipoedema is pain; it is described as dull, heavy, and pressing. The pain can be elicited by touch or pressure, or it can occur after standing or sitting for a protracted period, as well as at the end of the day . This tenderness makes high‐compression therapy challenging, particularly in cases where lipoedema is associated with the involvement of veins or lymphatics.…”

“…1,10,11 The overall prevalence of lipoedema in the general population is uncertain, and it has been reported to be as low as 0.1%; however, some studies conducted on outpatient's clinics estimate the prevalence to be 7% to 10%. 11 Whereas studies conducted on hospitalised patients demonstrated prevalence percentages between 8% and 18%. [10][11][12][13] In a trial in southern Germany, the prevalence was 10% among adult women.…”

“…11 Whereas studies conducted on hospitalised patients demonstrated prevalence percentages between 8% and 18%. [10][11][12][13] In a trial in southern Germany, the prevalence was 10% among adult women. 14 Despite the wide range of prevalence documented in various studies, we still believe that lipoedema is an uncommon disease.…”