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IntroductionAfter unification of diagnostic criteria for lipedema through guidelines and consensus documents as a fat-disproportion between abdomen and extremities with pain in the affected area, reduced by compression, expensive treatment options like liposuction should be reserved to affected women. Whilst the diagnosis of lipedema is obviously clinic, technical investigations or clear cut-offs shall help avoiding misuse of resources. The aim of this study was to find differentiation criteria between lipedema (LIP) controls (CO).MethodsInvestigator initiated exploratory investigation of 20 women per group, with interim analysis after completion of investigation of 10 women per group. 14 LIP and 12 CO were investigated with QOL-questionnaires (CIVIQ and Lymph), Wunstorf-Vein-Office anamnesis questionnaire, Visual Analogue Scale (VAS) of spontaneous pain, Pain under manual investigation, pain under compression cuffs, ultrasound of skin and subcutaneous fat tissue, share-wave-elastography, water content of skin (LymphScanner) and stiffness of skin (FibroScanner).ResultsStatistical evaluation between LIP and CO presented significant differences for all parameters excepting share-wave-elastography, water content and stiffness of the skin. Differences between controls and Lipedema were achieved with p < .0001 for the Wunstorf-Vein-Questionnaire, with p < .001 for CIVIQ (cut-off >40 Points for LIP), compression cuff (cut-off <60mmHG), with p < .01 Skin thickness (skin lateral thigh >2.1 mm in LIP), fat tissue thickness (ankle >18 mm).ConclusionThis first analysis could establish a series of clear cut-off values between lipedema and controls for medical history parameters (existence of pain and compliance with compression garments), pain sensitivity to palpation and pressure, and the results of at least one quality-of-life questionnaire (CIVIQ better than Lymph-QOL) and promising cut-offs for objective, technically measurable parameters, such as skin and subcutaneous fat thickness. The possibility to discriminate between lipedema and lipohypertrophy will be assessed in the second part of the investigation.
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Lymphological and fatty tissue disorders of the legs are increasingly tying up capacities in the health care system. This is related to the increase in obesity disease to almost endemic proportions in our society. Although the term lipedema was coined in the 1950s, it has only now become really well known. Women with lipedema suffer from symmetrical and disproportional fat deposition on both legs, accompanied by tenderness or strong pain especially on touch. Over 50 years, this condition has been underdiagnosed. Women with lipohypertrophy (same fat disproportion without pain) fear they suffer from lipedema and are misguided by false information, claiming treatment, as well as liposuction reimbursed by health care systems. Affected women suffer greatly from misinformation but also from overdiagnosis. The aim of this work is to make differential diagnosis easier for the health practitioner. On the basis of descriptions on visual inspection and palpation of the affected legs, the differential diagnosis is explained here, supported with many pictures. As a result, differentiation of the entities lipedema, lipohypertrophy, obesity, and lymphedema and their mixed forms is made easier for health practitioners in their daily work. Many studies are still needed to better understand the entity lipedema, and efforts are underway to change the name to avoid misunderstandings, as the condition “lipedema” does not seem to have water in the fatty tissue.
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This S2k guideline was developed on the initiative and under the German Society of Phlebology and Lymphology (DGPL) leadership. The guideline aims to optimize the diagnosis and treatment of lipedema. It is intended to bring together the different approaches of the respective professional groups in a consensus-based manner and thus offer a basic concept for the best possible treatment of patients with lipedema. Sixty recommendations were formulated and agreed on in diagnostics, conservative and surgical treatment options, psychosocial factors and self-management. The guideline is intended to reflect the current scientific knowledge and be widely used for diagnosis and treatment recommendations for patients with lipedema. In particular, the guideline comments on diagnostic criteria, differential diagnoses, and coinciding clinical pictures, their influence on diagnosis and treatment, sensible treatment measures, and self-management options. The lipedema guideline summarizes the current national and international evidence and the German expert consensus and derives recommendations for the best treatment for patients with lipedema. The recommendations in the guideline are intended as an orientation aid in the sense of action and decision-making corridors from which deviations are possible in justified cases.
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