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Systemic causes of leg edema include idiopathic cyclic edema, heart failure, cirrhosis, nephrosis and other hypoproteinemic states. Lymphedema may be primary, or secondary to neoplasm, lymphangitis, retroperitoneal fibrosis and, rarely (in the U.S.), filariasis. Thrombophlebitis and chronic venous insufficiency are not uncommon causes. Finally, infection, ischemia, lipedema, vascular anomalies, tumors and trauma can be responsible for the swollen leg.
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1. Lipoedema is described with an illustration of a recent case. 2. This condition should be distinguished from lymphoedema of the legs. 3. The differential diagnosis is discussed. 4. Comment is made on treatment.
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Lipedema is a chronic, progressive disorder of adipose tissue that predominantly affects women, characterized by symmetrical fat accumulation in the extremities, pain, and resistance to caloric restriction. Recent insights suggest that lipedema represents a hormone-driven gynecological fat disorder, in which estrogen receptor (ER) imbalance plays a central role. The predominance of ERβ activity and suppression of ERα signaling are hypothesized to drive adipose hypertrophy, fibrosis, and inflammation, particularly in the context of intracrine estradiol excess. This model aligns lipedema with other estrogen-sensitive conditions, such as endometriosis and uterine fibroids, and provides a novel framework for understanding its pathophysiology. Therapeutically, this reframing opens new perspectives for hormonal modulation using selective progestins (drospirenone, gestrinone) and metabolic adjuncts such as tirzepatide, beyond the current symptomatic or surgical approaches.
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Lipoedema is a chronic disease with various manifestation of symptoms, related to excessive deposition of subcutaneous adipose tissue in the legs, hips and buttocks. The scale of the problem is enormous and may affect up to one in five women. Lipoedema is often underdiagnosed and misdiagnosed with lymphedema, obesity or lipohypertrophy. In recent years, lipoedema has been diagnosed in an increasing number of younger women, and its first symptoms may manifest already in puberty. Even though it is often perceived as only an aesthetic problem, it has a huge impact on the quality of life, mental health, self-esteem or self-confidence. Moreover, lipoedema causes stigmatization, unfortunately also in healthcare professionals. Nevertheless, recently, diagnostic criteria (also ultrasound) have been created, and lipoedema has been classified in ICD-10 (E88.2). There are also more and more treatment options, with emphasis on the role of psychological care. Awareness and knowledge of lipoedema have also increased despite its underestimation but still is not enough. The multidimensional nature of lipoedema and its impact on many aspects of life highlights the essential role of comprehensive support to patients. Nowadays, in times of caring for mental health, it is crucial to increase public awareness and spread knowledge about lipoedema.
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