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Introduction Lipedema is a chronic, progressive condition that can result in considerable disability. In 2011, the Dutch Society of Dermatology and Venereology organized a task force to create guidelines on lipedema, using the International Classification of Functioning, Disability and Health of the World Health Organization. Guideline development Clinical questions on significant issues in lipedema care were proposed, involving (1) making the diagnosis of lipedema; (2) clinimetric measurements for early detection and adequate follow-up; and (3) treatment. A systematic review of literature published up to June 2013 was conducted. Based on available evidence and experience of the task force, answers were formed and recommendations were stated. The guidelines define criteria to make a medical diagnosis of lipedema, a minimum data set of (repeated) clinical measurements that should be used to ensure early detection and an individually outlined follow-up plan, pillars on which conservative treatment should be based and recommendations on surgical treatment options. Conclusions Little consistent information concerning either diagnostics or therapy can be found in the literature. It is likely that lipedema is frequently misdiagnosed or wrongly diagnosed as only an aesthetic problem and therefore under- or mis-treated. Treatment is divided into conservative and chirurgic treatment. The only available technique to correct the abnormal adipose tissue is surgery. Recommendations To ensure early detection and an individually outlined follow-up, the committee advises the use of a minimum data set of (repeated) measurements of waist circumference, circumference of involved limbs, body mass index and scoring of the level of daily practice and psychosocial distress. Promotion of a healthy lifestyle with individually adjusted weight control measures, graded activity training programs, edema reduction, and other supportive measures are pillars of conservative therapy. Tumescent liposuction is the treatment of choice for patients with a suitable health profile and/or inadequate response to conservative and supportive measures.
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Lipoedema is a disorder of adipose tissue that occurs almost exclusively in women; the pathophysiology and aetiology are yet not well understood (Wold et al, 1951; Child et al, 2010; Fife et al, 2010). The condition was originally described in 1943 by Allen and Hines (Wold et al, 1951). The exact prevalence of lipoedema in women is unknown; its presence in the general female population has been estimated at 11% (Földi and Földi, 2012). It is a chronic, progressive condition that is associated with considerable morbidity, including discomfort, easy bruising and tenderness of the disproportionately enlarged legs, which may progress to highintensity pain and limited mobility, along planus, and complaints about general fatigue and physical impairment are often observed. In later stages, body mass index (BMI) ≥30 kg/m2 (obesity) may also develop. Clinical characteristics of lipoedema include swelling and symmetrical enlargement of the lower limbs due to abnormal deposition of subcutaneous fat, with a sharp transition area of affected to unaffected tissue occasionally accompanied by over-hanging lipoedema tissue (Box 1). This is recognised as the typical ‘cuff-sign’, also called as ‘inverse shouldering’ or the ‘bracelet effect’. Lipoedema often co-exists with obesity, and obesity may be misdiagnosed, although Abstract
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The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed on the ICC website (http://www.icc-compressionclub.com/index.php). In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance, the day-long ICC meeting challenged a series of dogmas and myths that exist when considering compression therapies. In preparation for a discussion on beliefs surrounding compression, a forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments on each topic thereby widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference. This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.
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