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Lipedema: Which Etiological Pathways? Abstract. The pathogenesis and epidemiology of lipedema are uncertain, and its diagnosis often delayed. Lipedema almost exclusively affects women, and a link to sex hormones is likely. The metabolic risk of this accumulation of fat in the lower limbs is not known, and weight loss has no impact on the morphology of the lower limbs. Due to the aesthetic discomfort and frequent initial misdiagnosis which results in inappropriate treatment, this condition can lead to significant psychological suffering for the patient. A better understanding of this disease is essential to the proper diagnosis and support for these patients, as well as guiding them in the effective care.

Zusammenfassung Einleitung: Die aktuelle deutsche Leitlinie zur Behandlung des Lipödems empfiehlt neben der Therapie mit flachgestrickten Kompressionsmaterialien und manueller Lymphdrainage auch die Liposuktion. Die Abgrenzung zu Adipositas und asymptomatischer Lipohypertrophie stellt dabei häufig ein differenzialdiagnostisches Problem dar. Eine reproduzierbare und objektivierbare Differenzialdiagnostik ist aber die Grundlage für eine zielführende und wirtschaftliche Behandlung. Material und Methoden: Im Rahmen einer multizentrischen Registerstudie (5 Zentren) wurden im Zeitraum von 01/2016 bis 05/2017 die Beine (n=294) von Patientinnen mit Lipödem (n=136), Lymphödem (n=20), Lipödem mit sekundärem Lymphödem (n=30), Lipohypertrophie (n=42) und Adipositas (n=30) sowie von Gesunden (n=36) sonografisch untersucht. Es wurden Messungen der Dicke von Kutis und Subkutis an den Unter- und Oberschenkeln sowie von deren Komprimierbarkeit durchgeführt. Zusätzlich erfolgte eine Analyse der Sonomorphologie. Ergebnisse: Spezielle sonomorphologische Eigenschaften, die ein Lipödems von den anderen Krankheitsentitäten bzw. vom Gesunden abgrenzen lassen, konnten bislang nicht übereinstimmend und überzeugend herausgearbeitet werden. Die Komprimierbarkeit des Kutis-Subkutis-Komplexes ist vollkommen unspezifisch und lässt keinen Rückschluss auf die Diagnose Lipödem zu. Der Nachweis von Flüssigkeitseinlagerungen bei Patienten mit einer „schmerzhaften Lipohypertrophie” gelingt nicht, sodass die Krankheitsbezeichnung Lipödem irreführend ist und überdacht werden sollte. , Summary Introduction: The current German guidelines on treating lipoedema recommend using flatknitted compression material and manual lymphatic drainage as well as liposuction. Differentiating lipoedema from obesity and asymptomatic lipohypertrophy frequently proves difficult. However, a reproducible and objective differential diagnosis is the foundation of an expedient and cost-effective treatment. Material and Methods: As part of a multi-centre registry study (5 centres) ultrasound scans were performed between 1/2016 and 5/2017 on the legs (n=294) of a total of 147 patients with lipoedema (n=136), lymphoedema (n=20), lipoedema with secondary lymphoedema (n=30), lipohypertrophy (n=42) and obesity (n=30), as well as healthy individuals (n=36). Measurements were performed on the thickness of the cutis and subcutis of the lower and upper leg and on their compressibility. An analysis of the sonomorphology was also conducted. Results: Special sonomorphological properties that allow lipoedema to be differentiated from other disease entities and from healthy individuals have yet to be consistently and conclusively identified. The compressibility of the cutis-subcutis complex is completely unspecific and does not allow for any conclusions to be drawn concerning lipoedema. It has not been possible to detect fluid retention in patients with “painful lipohypertrophy” so that the description of the disease as lipoedema is misleading and should be reconsidered.

Unilateral lower extremity edema below the knee commonly results from deep venous thrombosis, venous insufficiency, or lymphedema. The patient history, a physical examination, and lower extremity venous duplex ultrasound often reveal the underlying etiology, which is frequently of vascular origin. Presently described is the case of a 23-year-old patient who underwent a diagnostic workup for unilateral leg swelling and was found to have a relatively uncommon cause of edema: lipedema. Lipedema is a disease characterized by subcutaneous adipose tissue deposition, and although diagnosed very rarely in general cardiology outpatient clinics, it has been demonstrated to be a cause of lower extremity edema in approximately one-fifth of cases in specialized clinics.

Unilateral lower extremity edema below the knee commonly results from deep venous thrombosis, venous insufficiency, or lymphedema. The patient history, a physical examination, and lower extremity venous duplex ultrasound often reveal the underlying etiology, which is frequently of vascular origin. Presently described is the case of a 23-year-old patient who underwent a diagnostic workup for unilateral leg swelling and was found to have a relatively uncommon cause of edema: lipedema. Lipedema is a disease characterized by subcutaneous adipose tissue deposition, and although diagnosed very rarely in general cardiology outpatient clinics, it has been demonstrated to be a cause of lower extremity edema in approximately one-fifth of cases in specialized clinics.

In this mini-review pathology, diagnosis, signs and symptoms, as well as treatment of lipedema are discussed. As the cause of lipedema is unknown for nearly 80 years, therapy is supportive and aimed at prevention of progression of the disease. Symptoms, signs and phenotypes of these patients are well defined. Guidelines for treatment are clear. When supportive therapy is inadequate surgical tumescent liposuction is the treatment of first choice. Surprisingly, the unproven compression and manual lymphatic drainage therapies of lipedma patients are covered by insurance, while the rational tumescent liposuction is not covered. Quality of life, mobility, lipedema pain, altered gait all improved by tumescent liposuction and disease progression is slowed. Insurance coverage of this procedure will help lipedema patients greatly. Cost-benefit analyses should be made. Research in pharmacotherapy of lipedema that makes sense should be stimulated

Introduction Lipedema (meaning edema in fat) and Dercum Disease (DD) are fat disorders in which accumulation of painful subcutaneous adipose tissue (SAT) affects more females than males, especially at times of female hormone change. Patients with both fat disorders are often misdiagnosed as obese. The purpose of this study was to determine if estrogen (ER) and progesterone receptors (PR) are different in lipedema versus DD in SAT and skin versus controls. These receptors are on mast cells that produce histamine causing leakage from blood vessels inducing hypoxia and angiogenesis. Progesterone is known to activate histamine release from mast cells. We aim to determine levels of ER and PR in SAT and if blood vessels replicate at a higher rate in lipedema and DD versus controls to help further understand these conditions and work towards finding a cure. Materials and Methods Immunohistochemistry (San Diego Pathology, San Diego, CA) was used to test for the presence of PR, ER, Ki67 (marker of replicating cells), and CD117 (marker of mast cells). Results and Discussion Mast cell numbers were similar in control, DD and lipedema SAT (Figure). ER were not different in control, DD and lipedema SAT. PR were significantly lower in lipedema SAT. There was no difference in Ki67 in lipedema or DD blood vessels compared to controls. Conclusion Lower numbers of PR in our data suggest mast cell secretions (histamine and others) could be higher inducing leakage from vessels and fluid collection in SAT. Fluid in the tissue should induce hypoxia and growth of more blood vessels. Despite higher PR on mast cells, lipedema blood vessels did not appear to be replicating at a higher level. With further research and additional samples, the relevance of elevated PR in lipedema tissue may become apparent. Support or Funding Information Research reported in this poster was supported by the National Institute of General Medical Sciences of the National Institutes of Health under linked Award Numbers RL5GM118969, TL4GM118971, and UL1GM118970. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Special acknowledgement to the Minority Health Disparities summer research program at the University of Arizona, the College of Medicine Tucson Treatment, Research, and Education of Adipose Tissue Program. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Lipedema is a chronic metabolic disorder of the adipose tissue, of unknown aetiology, and is marked by a bilateral and symmetrical swelling of the lower extremities, caused by extensive deposits of subcutaneous fatty tissue (local lipohypertrophy). Proliferative subcutaneous fatty tissue compresses the lymph collectors of the superficial lymphatic system. Lymphedema is characterized swelling of soft tissues by accumulation of lymphatic fluid [1]. If lipolympedema remains untreated, it will progress through the same stages as pure lymphedema [1,2]. A helpful diagnostic tool to distinguish lipedema from lymphedema is Stemmers sign. Limb circumference or volume measurements are commonly used for diagnosis and for following lymphedema progression [3]. Developing technology also brings new approaches for lymphedema diagnosis: bioimpedance, 99mTc lymphoscintigraphy, magnetic resonance lymphangiography etc. Ultrasound is recently developing imaging technique for both lymphedema diagnosis and follow up [4]. In this case report localized lipedema which diagnosed with ultrasonography, in a patient with osteoarthritis in the knee joint was discussed.

Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on selfesteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limitedmobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.

Lipoedema is a condition characterised by symmetrical lower limb enlargement. It was first described by Allen & Hines who coined the term lipoedema. The result of subcutaneous deposition of fat gives rise to fatty swelling in the buttocks, thighs and lower limbs sparing the feet. It is associated with obesity and hence upper limbs and rarely trunks are also affected.  This Clinical condition affects females predominantly 1:4 and hence has a profound effect on the psychology therefore it is not uncommon to see these patients with a low self esteem, socially isolated and depressed. Due to its resemblance to lymphoedema it is not unusual to be misdiagnosed, thus leading to a spiral of inappropriate tests and improper treatment outcome.

INTRODUCTION: Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields. MATERIALS AND METHODS: This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique. RESULTS: Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery. CONCLUSION: Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

Lipedema an often overlooked but treatable disease Lipedema is a painful disease that affects some women between puberty and menopause through a subcutaneous fat accumulation especially in the lower extremities. Patients suffer from pain and pressure tenderness. The larger fat accumulation, especially on the inside of the thighs and knees, causes walking difficulties. This can successfully be treated by liposuction with good long-term results in terms of pain reduction and prevention of osteoarthritis development in the knee and ankle joints.

Lipoedematous scalp (LS) is an extremely rare condition characterised by a soft and boggy consistency in the scalp due to an increased layer of subcutaneous tissue.In this report, we present a case of LS in a 64-year-old Indian woman. Clinical examination revealed only vague boggy lumpiness involving the whole of occipital scalp extending to parietal scalp. MRI scalp showed diffuse fatty infiltration of the scalp, particularly at the posterior parietal and occipital convexity extending to both lateral aspects of the cranium, with homogeneous signal in keeping with fat. Incidentally MRI also found diffuse fatty infiltration of the parotids.The aethiopathogenesis of LS is still unknown, however it is believed that the hormone leptin could be the key hormone in the dysregulation of fat deposition and distribution. This case report highlights the subtle features with which these cases can present and explores the literature on reported cases of LS.

Lymphoedema results from a failure of the lymphatic system. The consequences are swelling, skin and tissue changes and predisposition to infection. Lipoedema, however, results from the predisposition of an excessive number of fat cells in the lower limbs, typically from the ankle to the waist. Management for lymphoedema consists of volume reduction, reduction in shape distortion and improvement of skin condition. Treatment consists of a two-phase approach including an intensive and maintenance phase. The maintenance stage of treatment or self-care consists of skin care, exercise and compression garments. Case studies are presented featuring lower limb lymphoedema and upper limb lymphoedema and a patient affected by lipoedema. The case studies demonstrate how JOBST Elvarex custom-fit, flat-knit compression garments with knee and elbow functional zones enhances patient choice, garment suitability and potential for improved quality of life.

Self-management and the use of adjustable velcro compression wraps are not new concepts and quite often both can form part of the maintenance phase of treatment in those with lymphoedema or lipoedema, as well as those diseases in which compression therapy is advised as long-term management. The aim of this article is to identify some aspects that contribute to effective self-management and how the use of easywrap adjustable velcro compression wraps have improved quality of life for those with lymphoedema, chronic oedema and lipoedema. Case studies are given from patients to demonstrate the individual experience of living with lymphoedema or lipoedema, how this has impacted on daily life, and how using easywrap has helped as part of self-management.

Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on self-esteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limited mobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.