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Lipedema is a chronic disorder characterized by the symmetrical accumulation of subcutaneous adipose tissue, predominantly affecting women. Despite increasing recognition, the pathophysiological mechanisms underlying adipose tissue dysfunction in lipedema remain incompletely understood. This mini review combines current knowledge about adipose tissue biology in lipedema, highlighting recent discoveries, ongoing controversies, and future research directions. A comprehensive literature review was conducted focusing on adipose tissue-related research in lipedema with emphasis on pathophysiological mechanisms, cellular composition, and therapeutic implications. Recent studies reveal that lipedema adipose tissue exhibits distinct characteristics, including M2 macrophage predominance, stage-dependent adipocyte hypertrophy, progressive fibrosis, and altered lymphatic/vascular function. The inflammatory profile differs markedly from obesity, with an anti-inflammatory M2-like macrophage phenotype rather than the pro-inflammatory M1 response seen in classic obesity. Emerging evidence suggests lipedema may represent a model of "healthy" subcutaneous adipose tissue expansion with preserved metabolic function despite increased adiposity. Current research proposes menopause as a critical turning point, driven by estrogen receptor imbalance and intracrine estrogen excess. Lipedema represents a unique adipose tissue disorder distinct from obesity, characterized by specific cellular and molecular signatures. Current research gaps include the need for validated biomarkers, standardized diagnostic criteria, and targeted therapeutics. Future research should focus on elucidating the molecular mechanisms driving adipose tissue dysfunction and developing precision medicine approaches.

Lipedema is a clinical entity that deserves special attention, as it predominantly affects women during specific hormonal phases such as menarche, pregnancy and menopause. Among the available treatments, surgery is considered the most invasive and is usually indicated for severe cases. As an alternative, conservative therapies may be recommended, including photobiomodulation therapy (PBMT), which still requires scientific substantiation to validate its effectiveness. We conducted a clinical study involving three patients who underwent dermolipectomy for previously indicated medical reasons. Prior to surgery, PBMT was applied using red and infrared LED irradiation on one side of the body, with the contralateral side serving as a non-irradiated control. PBMT was administered 3–4 h before the surgical procedure. The excised skin samples from both treated and control sites were subjected to histopathological analysis. Qualitative assessments (H&E staining) and adipocyte histomorphometry were performed, alongside immunohistochemistry using the following markers: caspase-3 (apoptosis), CD68 (macrophages), COX-2 and Cytochome P4501A1 (CYP1A1). Results demonstrate positive effects, including a reduced adipocyte size in irradiated sites modulation of inflammatory process and increasing COX-2 and macrophage activity in this early post-treatment phase, enhanced adipocyte apoptosis, and upregulation of aromatase (CYP1A1). These membrane-associated hemoproteins are known to catalyze mono-oxygenation of both endogenous and exogenous substrates such as hormones, fatty acids. This is the first study to investigate the effects of PBMT in lipedema patients. Despite is preliminary nature, the findings suggest that PBMT exerts beneficial biological effects on lipedema tissue when applied under the tested parameters.

This article aims to summarize contemporary understanding and management strategies of lipedema. It will elucidate recent advancements in diagnostic methodologies, the role of imaging technologies, and evolving therapeutic interventions. The article will further delineate critical areas that warrant further investigation.

Background: We aimed to assess the sleep quality and the relationship between sleep and fatigue and quality of life in female lipedema patients.Methods and Results: A total of 52 patients with lipedema (Group 1) and 40 healthy control subjects (Group 2) were enrolled. The type and stage of lipedema were recorded for Group 1. The quality of sleep was assessed by using the Pittsburgh Sleep Quality Index (PSQI). The Fatigue Severity Scale (FSS) was used for assessing fatigue. Quality of life was assessed with the World Health Organization Quality of Life. The mean age of the patient group was 45.26 ± 9.81, whereas it was 42.10 ± 6.36 years in the control group (p > 0.05). The mean body mass index was 30.23 ± 4.70 in Group 1 and 28.55 ± 4.14 in Group 2 (p > 0.05). The total PSQI score was 10 (range: 7–12.75) in Group 1 and 8 (range: 5–10) in Group 2 (p < 0.05). There was no difference between the groups in terms of FSS. In the assessment of quality of life, only the physical function domain was significantly poorer in Group 1 than in Group 2 (p < 0.05). Physical function was correlated with subjective sleep quality, sleep disorder, and daytime dysfunction; fatigue was correlated with sleep disorder, daytime dysfunction, and use of sleep medications (p < 0.05). There was a correlation between the total PSQI score and physical functioning and fatigue (p < 0.05).Conclusion: Female patients with lipedema have poor sleep quality and decreased quality of life. Sleep disturbance is associated with both physical function and fatigue. Quality of sleep should be questioned in every assessment of patients with lipedema.

Background Lipedema is a chronic adipose tissue disorder affecting primarily women and is increasingly associated with immune dysregulation and intestinal permeability. Food-specific IgG testing has been explored in various inflammatory conditions, but its relevance to lipedema remains unknown. Objective The objective of this study is to characterize IgG food sensitivity profiles in women with lipedema and investigate the paradoxical relationship between increased food reactivity and reduced total IgG antibody levels. Methods We conducted a retrospective cross-sectional study involving 234 participants: women with lipedema (n=80), women without lipedema (n=74), and men (n=80). All had undergone IgG testing against 222 food antigens via ELISA. We analyzed qualitative (positive/negative) and quantitative IgG reactivity, applied dimensionality reduction (PCA, t-SNE) and clustering, and developed a multivariable logistic regression model to assess diagnostic performance. Results Women with lipedema exhibited a non-significantly higher number of positive IgG food reactions (14.8 vs 12.6; p=0.186), despite significantly lower total IgG levels (1747.1 vs 2974.8 AU; p<0.001). This paradox was consistent across 79.7% of tested antigens. The most discriminative foods included wild game meats and certain vegetables. A combined IgG-based model achieved an area under the curve of 0.804, outperforming individual IgG metrics. Dimensionality reduction revealed no clear clustering based on reactivity patterns alone. Conclusion Lipedema displays a paradoxical IgG signature, more frequent positives despite lower total IgG, consistent with mucosal immune dysregulation (e.g., increased intestinal permeability, immune exhaustion, or dietary monotony). Single IgG metrics had limited discrimination, but a combined score improved classification, supporting IgG profiling as a complementary, not standalone, biomarker for patient stratification and personalized dietary guidance. Collectively, these findings suggest that the adipose phenotype may be downstream of broader systemic processes; prospective studies should assess IgG subclasses, barrier markers (e.g., zonulin), and gluten-modulated interventions.

Lipedema is a chronic condition characterised by abnormal fat distribution in the limbs, particularly the lower body. It leads to accumulation of tender,

For the millions of women living with lipedema worldwide, finding effective treatment options has been a long and frustrating journey. However, recent research is shedding light on a potential new avenue for treatment: GLP-1 receptor agonists, particularly tirzepatide. What is Lipedema? Lipedema is a chronic medical condition characterized by the abnormal accumulation of fat cells,

Liposuction in lipedema is a safe and effective treatment, but there currently are no studies analyzing the individual complications of water-jet-assisted liposuction in lipedema or the impact of the cannula’s design.To answer the question which WAL cannula is the safest in lipedema patients, and providing practitioners with the data they need to make an informed decision about the cannula they choose.We retrospectively analyzed complications and their underlying risk factors in 117 patients across 243 cases. Groups were formed by diameter (Ø) and number of ports of the used cannulas. Unpaired t-Tests, Fisher’s exact tests and chi-squared tests were used to analyze the patients’ characteristics for the complication rates across the cannulas.Cannulas with 8 ports showed statistically significantly higher hemoglobin loss (p = 0.011), shorter incision-to-suture time (p = 0.023), and higher volume of aspirated fat (p &lt; 0.001). The same results occurred when comparing the Ø 3.8mm cannulas that differ in the number of ports (4 versus 8 ports). The Ø 4.8mm group showed a significantly increased rate of wound healing disorders compared to the Ø 3.8mm group (p = 0.041) and a statistically significantly higher aspirated fat volume (p = 0.014).No specific cannula showed superior safety in terms of complication rates. However, 8 port cannulas facilitated a faster aspiration of large volumes and reduced the incision-to-suture time compared to 4 port cannulas. This benefit was accompanied by a grater loss of hemoglobin. In contrast, cannula diameter played a less significant role in aspiration speed and did not increase the hemoglobin loss.

Background: Lipedema, a chronic condition affecting mostly women, involves painful bilateral increase of subcutaneous adipose tissue. The societal impact of this disease is still poorly understood. This study aimed to validate the Lymphedema Quality-of-Life Questionnaire (LYMQOL) for lipedema patients in Germany, assessing its feasibility, reliability, and validity.Methods and Results: A total of 81 German-speaking stage II lipedema patients were asked to complete both the LYMQOL (arm and leg versions) and the Short Form Health Survey (SF-36) questionnaires twice, and this was 2 weeks apart. Feasibility was evaluated through response rates, scale structure via factor analysis, validity through SF-36 correlations, and reliability through internal consistency and test-retest reliability analysis. A valid 68% response rate was achieved. Both arm and leg versions demonstrated construct validity with significant correlations to SF-36 subscales. Internal consistency for the leg version was acceptable to excellent, and good to excellent for the arm version. Test-retest reliability was very good for both versions.Conclusions: This study validates the LYMQOL as a robust tool for assessing lipedema patients’ quality of life, and also validates the German translation contained in this article. We hope to fill a critical research gap and support future clinical studies aiming at enhancing patient care.

Background Lipedema is a chronic, progressive condition characterized by symmetrical accumulation of adipose tissue, predominantly in women's lower extremities. It is frequently associated with pain, reduced mobility, and psychological distress. Dietary interventions have become central to conservative management of the condition, yet their clinical efficacy remains unclear. Methods This systematic review included peer-reviewed studies assessing dietary strategies in individuals with clinically diagnosed lipedema. Searches were conducted in four databases in July 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies applied dietary interventions and reported clinical or psychosocial outcomes, and the risk of bias was subsequently assessed. Results Nine studies involving 269 women met the inclusion criteria. The majority applied hypocaloric dietary protocols, particularly ketogenic, low-carbohydrate high-fat, or ketogenic modified Mediterranean diets. Across studies, weight loss and reduction in fat mass were consistently reported. Some studies also observed improvements in pain, inflammation, and quality of life, though these outcomes were not uniformly assessed. Few studies used advanced measures of body composition such as dual-energy X-ray absorptiometry or magnetic resonance imaging; most relied on bioelectrical impedance analysis. Only one study evaluated emotional dysregulation and only one assessed food addiction, but no study systematically measured eating behavior traits, or current or past eating disorders. Intervention durations ranged from four to twenty-eight weeks, and adherence strategies varied. The risk of bias was moderate to high in most studies. Two trials (conducted by Lundanes and Jeziorek et al.) were randomized controlled trials, whereas the remaining studies used non-randomized designs despite including control and intervention groups. Due to the high heterogeneity in study design, outcomes, and measurement tools, combined with the small sample sizes and risk of bias, it was not possible to conduct a meta-analysis. Conclusion The effects of dietary approaches on lipedema remain unclear. Future studies should adopt robust methodological designs, include larger and stratified samples based on disease stage, use accurate assessments of body composition (including muscle mass and strength), evaluate mental health and eating behaviors, and investigate the long-term sustainability of interventions. The literature lacks standardized methodologies and comprehensive evaluation of psychosocial and eating behavior, highlighting the need for stronger evidence to inform clinical practice.

Dercum disease and lipedema commonly present with joint hypermobility, yet the relationship between these adipose disorders (AD) and hypermobile Ehlers-Danlos syndrome (hEDS) remains insufficiently understood. To date, no research has simultaneously examined hEDS and adipose disorders, leaving a critical gap in understanding their interplay. This investigation seeks to address diagnostic challenges and provide insights to inform more effective management strategies for these complex, overlapping conditions.

Lipedema is a chronic, often misdiagnosed disease characterized by painful, disproportionate fat accumulation in the extremities. Commonly mistaken for obesity or lymphedema, lipedema primarily affects women and has long been thought to be resistant to dietary intervention, a belief originating from its initial description by Allen and Hines at the Mayo Clinic in 1940. However, emerging research challenges this notion, revealing that individuals with lipedema often respond positively to therapeutic carbohydrate (CHO) reduction, particularly ketogenic diets (KD). Effective management of lipedema requires a comprehensive, holistic approach. Nutritional strategies should not only target symptom relief but also support overall health by considering physical comorbidities, mental and emotional well-being, and individual cultural and social factors. In this paper, we present an updated perspective on CHO-reduced dietary interventions for lipedema and propose a patient-centered framework to personalize nutrition plans for sustained success and improved quality of life.

Introduction:Lipedema is a progressive chronic condition that mainly affects women, and is characterized by disproportionate subcutaneous fat accumulation in the extremities, causing pain, edema, and impaired quality of life.Objective:This study evaluated the outcomes of the lipedema definition technique (LDT) for the treatment of lipedema, focusing on clinical efficacy, quality of life improvement, and patient satisfaction.Methods:A retrospective study was conducted with 67 women who underwent the LDT to treat lipedema (types II to V and stages 1 to 4). Analyzed variables included weight, body mass index, body fat percentage, total body water, InBody score, ideal weight, fat-free mass, basal metabolic rate, waist-to-hip ratio, visceral fat level, and percentage of obesity. The Lipedema Symptoms Assessment Questionnaire and complementary questionnaire were applied to assess satisfaction and clinical outcomes. Study assessments were conducted preoperatively, 90 days after surgery, and completed 2 years later.Results:A total of 34 patients (mean age of 40 years) were included; most had stage 2 lipedema (50.7%) and type IV (49.2%). After 90 days of the LDT, significant reductions were observed in weight (−2.5 kg, P = .001), body mass index (−0.9 kg/m2, P = .001), body fat percentage (−3.1%, P = .001), visceral fat (−1.8 points, P = .001), and percentage of obesity (−4.3%, P = .001). Moreover, fat levels in the upper and lower quadrants were significantly reduced, and bioimpedance analysis showed changes in all 5 body segments after LDT. Improvements in quality of life (89.4%) and pain reduction (87.2%) were reported. High satisfaction rates (91.5%) were observed, with 81.0% of patients reporting positive outcomes and 75.0% maintaining results in the long term.Conclusion:Lipedema definition technique was effective in reducing fat, improving quality of life, and achieving high patient satisfaction. This study reinforces the role of surgery as an intervention for lipedema, promoting important clinical and aesthetic benefits.

Lipedema is a chronic, progressive adipose connective tissue disorder characterized by symmetrical, disproportionate fat accumulation, typically affecting the lower extremities and arms, accompanied by pain, swelling, and a sensation of heaviness. This study introduces intermediate Stages 1.5 and 2.5 to the established lipedema classification (Stages 1, 2 and 3), and other affected areas, based on physical examination, a questionnaire, and photographic documentation. Bioelectrical Impedance Spectroscopy (BIS) was employed to quantify total body water (TBW) across stages. A significant and linear increase in BMI was observed from Stage 1 to 3, correlating with increased reported pain and heaviness in the thighs, calves, and upper arms. Systemic symptoms of brain fog, debilitating fatigue, and hypothermia were significantly prevalent. TBW demonstrated a significant, stage-dependent increase in the lower extremities. Adipose tissue accumulation over the knees and feet significantly increased with lipedema stage. In contrast, shin involvement was evident in early stages and remained consistently elevated throughout later stages. Skeletal Muscle Mass (SMM) exhibited a significant increase across lipedema stages, positively correlating with fat mass (FM) in Stage 3. This study elucidates previously underrecognized clinical features and distribution patterns of lipedema, offering a refined staging system to improve understanding of its progression and burden.

Estrogen-dependent conditions, such as endometriosis, adenomyosis, lipedema, polycystic ovary syndrome, and breast cancer, are intimately involved with hormonal changes related to estrogen and their receptors. These conditions can be expressed mainly during hormonal changes such as pregnancy, puberty, and menopause. They are associated with alterations in estrogen function and inflammatory mechanisms, leading to significant discomfort and a marked decrease in self-esteem in women. Resveratrol has been studied in the treatment of inflammatory diseases like obesity, metabolic syndrome, and endometriosis. The research suggests potential pathways through which resveratrol may also be beneficial in treating metabolic and estrogen-dependent conditions. We reviewed 63 articles from 2000 to 2025, prioritizing systematic reviews, meta-analyses, and randomized controlled trials in the PubMed, ScienceDirect, and SciELO databases. Our results suggest that resveratrol may benefit metabolic and estrogen-dependent conditions by modulating anti-inflammatory factors that regulate estrogen receptor activity, increasing lipolysis, decreasing insulin resistance, and mitigating oxidative stress. Future research should evaluate the long-term safety and potential therapeutic effects of resveratrol in metabolic conditions.

Background/Objectives: Lipedema is a chronic and progressive adipose tissue disorder characterized by the abnormal accumulation of subcutaneous fat, predominantly in the legs and occasionally in the arms. The symptom that most signi cantly affects the quality of life is pain. Ultrasound elastography is an imaging technology that allows for measuring tissue stiffness quantitatively. This study aims to evaluate the relationship between accompanying pain in patients with lipedema and tissue elasticity measured using shear-wave elastography (SWE). Methods: Our study was designed as an observational, analytical and cross-sectional study. The visual analog scale (VAS) was used to assess pain, while the PainDetect questionnaire was utilized to evaluate neuropathic pain. The evaluation of tissue elasticity and brosis was conducted using the SWE method. Results: This research assessed thirty- ve patients, revealing an average age of 45.2 years and an average VKI of 33.6 kg/m². 60% of the patients had a lipedema diagnosis in their family history. Both age (p<0.01) and BMI (p<0.001) values were moderately correlated with all subcutaneous adipose tissue measurements, while no correlation was observed in SWE measurements. Only the level of the thigh in the SWE-Elasticity (SWE-E) values was related to VAS (p=0.03). Additionally, PainDetect data revealed correlations with SWE-Velocity (SWE-V) and SWE-E in both the right and left thighs. Conclusions: While SWE measurements were not correlated with skin adipose tissue, SWE measurements were correlated with pain and neuropathic pain in patients with lipedema. This nding highlights a potentially important relationship between tissue elasticity and pain, which may warrant further exploration.

Lipedema is a chronic and progressive condition characterized by the disproportionate accumulation of subcutaneous adipose tissue predominantly in the upper and lower limbs, sparing the trunk, hands, and feet. It affects approximately 12.3% of the female population in Brazil. Clinically diagnosed, its most common symptoms include tenderness upon palpation and spontaneous bruising. During the development of a qualitative ultrasonographic classification for lipedema, termed Lipedema Dermis and Hypodermis Classification (LDHC), an echogenic nodule was identified in the superficial hypodermis. This nodule was painful upon superficial palpation and lacked ultrasonographic features of a lipoma. The patient presented with a nodule in the distal posterior region of the right thigh and another on the distal posterior of the right arm. Given the possible differential diagnoses, including neoplasia and angiodysplasia, an ultrasound-guided biopsy was performed. Macroscopic analysis revealed an oval-shaped, reddish nodule, suggestive of blood content. Histological analysis revealed areas of steatonecrosis, hemorrhagic foci, and neoangiogenesis with irregular architecture and fragile vessel walls. Complementary analysis of the resistance index (RI) of superficial hypodermal arteries demonstrated an increased RI in the lipedema patient compared to the control. All these findings suggest that the tissue is hypoxic and characterized by chronic inflammation, supporting the hypothesis of increased subcutaneous compartment pressure in lipedema. This case report elucidates the ultrasonographic findings of nodules classified by LDHC through microscopic anatomical correlation and aids in understanding the pathophysiological mechanisms underlying lipedema.

To determine the frequency of neuropathic pain in patients with lipedema and to assess the impact of neuropathic pain on quality of life and its correlation with clinical variables.

Objectives To identify research priorities related to the diagnosis, treatment and management of lipoedema. Design This was a research question priority-setting that ensured the involvement of patients, relatives and healthcare professionals in all parts. It consisted of the following steps: identifying research questions through an open survey, seeking input from patients, patient relatives and healthcare professionals. Prioritisation, including a Delphi exercise and a final priority-setting meeting. Setting Swedish healthcare and community. Participants A total of 255 participants submitted research questions. 130 participated in the prioritisation of the submitted questions. Of these, 89 were patients, 10 were relatives, 19 were healthcare professionals and 12 were representatives of patient organisations. Results 1314 potential research questions were submitted; 62 unique questions remained after analysis. 130 and 123 people answered the first and second Delphi surveys, respectively. 20 questions were discussed by 13 participants at the final priority-setting meeting. The following five research questions were selected as a top priority: (1) what criteria should apply for a diagnosis of lipoedema? (2) What outcomes are important in lipoedema research? (3) What effect does manual treatment, such as manual lymphatic drainage have on lipoedema? (4) What effect does liposuction have on lipoedema? (5) What are the effects of hormonal treatment on lipoedema? Conclusions We found a consensus between patients and healthcare professionals on topics that warrant priority in future research into lipoedema. The questions reflect both the diagnosis of the condition and research on treatment effects. We hope the results will inform researchers and research funders, and direct future studies towards important research questions. Data are available upon reasonable request.

Lipedema is a chronic adipose tissue disorder traditionally considered to affect almost exclusively women, with recent estimates suggesting approximately 0.2% prevalence in men worldwide; the condition remains underdiagnosed in males due to limited awareness and scarce literature. This retrospective case series from the Amato Institute of Advanced Medicine in São Paulo, Brazil, describes clinical characteristics, diagnostic findings, and treatment outcomes of five male patients diagnosed with lipedema between January 2022 and December 2024. The patients, aged 31-58 years (mean, 42.6 ± 9.7), with a BMI of 29-42.4 kg/m², all presented bilateral, symmetrical lower extremity fat accumulation, sparing the feet, with endocrine comorbidities present in 80% of cases and one participant testing positive for HLA-DQ2/DQ8. Diagnosis was based on clinical criteria requiring bilateral symmetrical fat accumulation, disproportionate fat distribution, negative Stemmer’s sign, sparing of feet, and at least two minor criteria. Conservative management, including dietary interventions over four to eight weeks, resulted in mean weight reduction of 7.0 ± 2.2 kg and lower limb volume reduction of 2.5 ± 1.1 L. These findings demonstrate that lipedema occurs in men with classical phenotypic features, and the presence of HLA-DQ2/DQ8 markers in some cases suggests potential autoimmune components and opportunities for targeted dietary interventions. Conservative management yields significant short-term improvements, warranting larger prospective studies to establish prevalence, investigate HLA associations, and optimize management strategies for male lipedema.