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Lipedema is a chronic fat disorder with disproportional fat distribution, especially around the legs, hips, and sometimes arms, and it affects women almost exclusively. The major symptoms and complaints include pain in the soft tissue and the feeling of “heavy legs.” The perception of pain depends to a high degree on the psychological condition of the patient. Obesity is the major comorbidity and can worsen lipedema. In combination with impaired levels of physical activity, there is an increase in interstitial filtration, and noninfectious inflammation with capillary leakage can occur. Eventually, chronic edema develops due to the dynamic insufficiency of the lymphatic system. However, edema is not a pathognomonic aspect of lipedema. There are many controversies and myths about the condition lipedema, and no objective diagnostic tool is available to confirm the diagnosis. Therapeutic approaches in lipedema are multimodal and focus on the biomedical, psychological, and functional aspects involved with the disorder. A lifestyle change is often part of the therapeutic program, along with other therapeutic interventions, such as exercise, compression, weight management, and nutritional and psychological support. Clinimetrics with validated techniques in all fields of human functioning of a lipedema patient are mandatory to objectively evaluate the improvements that are due to the treatment program. Liposuction is a technique to remove fat and is therefore introduced to treat lipedema. Some doctors who offer the procedure state that “liposuction leads to comprehensive and long-term improvements in lipedema and cures the disease.” These statements are often too optimistic and lead to high costs for the patient and disappointment in the end. However, liposuction can lead to improvements in lipedema when offered within a therapeutic program that includes other nonoperative modalities for the correct selection of patients according to their medical criteria. It cannot be emphasized enough that liposuction is not a method that should be used to treat obesity.

The easiest way to differentiate lipedema from lymphedema is to detect lipedema-associated clinical symptoms (e.g., cuffing sign, retromalleolar fat pads, tenderness of the skin). Physical examinations including the Streeten test, waist-to-height ratio, capillary fragility, and pain measurements can also aid in differential diagnosis. The last two methods can be used to follow and measure therapeutical efficacy. Imaging techniques (ultrasound, computed tomography, magnetic resonance imaging, lymphoscintigraphy, infrared fluoroscopy) and cardiovascular methods (aortic stiffness determination, three-dimensional speckle tracking echocardiography) are sensitive tools to find subtle differences.

Lipedemawas first described by Allen and Hines in 1940 (1).Today, however, a large number of physicians remain unaware of the disease and its symptoms. Many lipedema patients are not correctly diagnosed or effectively treated until after they have endured decades of suffering (2). Epidemiological statistics on the incidence of lipedema are not available. An investigation of patients treated at one lymphedema clinic from 1995 to 1996 revealed lipedema in approximately 15% of the patients treated on an inpatient basis (3). A similar number (8% to 17%) was reported in surveys carried out in 2003 in four lymphedema clinics in Germany (4). In contrast to lymphedema, literature on lipedema is extremely sparse. Lipedema findings in the Anglo-American literature in particular often report only isolated case studies (5-8). Many more publications, including a monograph, are available in German literature (9). Table 7-1 lists synonyms for lipedema.

Lipedemawas first described by Allen and Hines in 1940 (1).Today, however, a large number of physicians remain unaware of the disease and its symptoms. Many lipedema patients are not correctly diagnosed or effectively treated until after they have endured decades of suffering (2). Epidemiological statistics on the incidence of lipedema are not available. An investigation of patients treated at one lymphedema clinic from 1995 to 1996 revealed lipedema in approximately 15% of the patients treated on an inpatient basis (3). A similar number (8% to 17%) was reported in surveys carried out in 2003 in four lymphedema clinics in Germany (4). In contrast to lymphedema, literature on lipedema is extremely sparse. Lipedema findings in the Anglo-American literature in particular often report only isolated case studies (5-8). Many more publications, including a monograph, are available in German literature (9). Table 7-1 lists synonyms for lipedema.

Compiled by an internationally renowned pioneer in the field of lymphology with contributions from leading experts, this textbook explores all aspects of lymphological science, including the causes, diagnoses, prognoses, and treatments for primary and secondary Lymphedema. Comprehensive discussions address all the essential topics relevant to lymphology, such as anatomy, physiology, and pathophysiology. Therapists will benefit from practical information on clinical findings as well as instructions for performing manual lymph drainage.Provides a detailed presentation of the anatomy and physiology of the lymphatic system.Explores the causes, diagnoses, therapies and prognoses of all lymphological conditions from a physician's perspective.Includes a well-founded and practical discussion on the techniques, effects and implementation of Complete Decongestive Therapy (CDT).

Lipedema of the lower extremities are diagnosed on the basis of clinical findings . An exact differentiation is necessary since therapeutical considerations are depending on the pathophysiology of the diseases. In lipedema (Allen and Hines) as weil as in erythrocyanosis cruris puellarum (Klingmüller) an examination of the state of the lymphatic vessels is justified. Using isotope lymphography the lymphatic capacitY, of the lower extremities can be assessed without problem. As demonstrated a disturbance of lymphatic transport is not regularly present in these two syndroms. Therefore we can not consider them as lymphedema. The frequent appearance of unilateral lymphostasis with definite clinical differenccs of both extremities indicate on the other band that lipedema is not seldom superimposed by the lymphedema .

La classification des lymphoedèmes en diverses catégories étiologiques est importante autant pour le diagnostic que pour un programme thérapeutique correct. L'approche diagnostique idéale doit Par conséquent envisager toutes les conditions, autant congénitales qu'acquises, responsables de la perturbation de la circulation lymphatique. Dans toutes les formes l'anamnèse est d'intérêt fondamental pour arriver au diagnostic étiologique alors qdu' e l'exame n c1 m· 1· que su ffii t a· poser le si·m ple iagnostic de lymphoedème.