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What is lipoedema?

Lipedema, also known as adiposis dolorosa, is a prevalent adipose tissue condition that is thought to afflict up to 11 percent of adult women all over the world. It is most frequently characterised by excessive fatty tissue laydown in the legs (medically referred to as adipocyte hypertrophy of the lower extremities), pain on light touch, and an inability to respond to intensive weight reduction techniques.

Lipoedema involves abnormal fatty tissue being laid down in the tissues resulting in painful legs.

What does lipoedema look like?

The typical presentation is a lady with bilateral “stovepipe” expansion of the legs and no involvement of the feet, accompanied by a strong demarcation between normal and aberrant tissue around the ankle, sometimes known as the “cuff sign.” This is frequently coupled with a symmetrical involvement of the arms, especially the upper arms, and a sparing of the hands. Extremely infrequently, lipoedema can affect only the arms without affecting the legs.

Lipoedema progresses in stages.

The stages of lipoedema

Three patients who highlight common clinical findings associated with lipedema. A, A 52-year-old woman with type 3/4 lipedema, stage 2. B, A 51-year-old woman with type 3 lipedema, stage 2/3. Note the profound discrepancy between the patient’s upper trunk and extremity adiposity. C, A 37-year-old woman with type 1/2 lipedema, stage 3. Source: Buck DW, Herbst KL. Lipedema: a relatively common disease with extremely common misconceptions. Plastic and Reconstructive Surgery Global Open. 2016 Sep;4(9). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND).

How is lipoedema diagnosed?

Typically a clinical diagnosis is made based on signs and symptoms.

  1. Bruising
  2. Pain on light touch
  3. Bilateral (both legs) presentation that is symmetrical
  4. Signs of fatty tissue laydown
  5. Non pitting (no signs of a lot of lymph fluid)
  6. Not usually associated with wounds or discolouration of the lower legs (as for venous disease)
  7. Usually diagnosed in women
  8. Different presentation to obesity with specific areas of fatty tissue laydown

References:

1/ Buck DW, Herbst KL. Lipedema: a relatively common disease with extremely common misconceptions. Plastic and Reconstructive Surgery Global Open. 2016 Sep;4(9). Access here.

2/ Shavit E, Wollina U, Alavi A. Lipoedema is not lymphoedema: A review of current literature. International wound journal. 2018 Dec;15(6):921-8. Access here.