lipoedema

Lipoedema: short overview

• symptoms: symmetrical augmentation of adipose tissue on legs (and / or arms), pressure and tension pain, tendency to bruising
• Therapy: Physiotherapy (eg lymph drainage, compression); Liposuction (in severe cases and inefficiency of other therapies)
• Reason: not clearly clarified; hormonal and genetic reasons are suspected;
• Forecast: no cure possible; but with the right therapy you can relieve the symptoms and stop the progression of the disease;
• competent specialists: Dermatologist, Phlebologist (Phlebologist), Lymphogist (Lymphologist)

Lipoedema: symptoms

In a lipoedema, it comes to a Propagation of fatty tissue on the extremities, Most patients are affected by the legs. That’s why laymen sometimes speak of rider’s trouser syndrome. But there are also patients in whom the lipoedema develops on the arms (especially the upper arms). Occasionally, both arms and legs are affected. Very rarely do other body regions develop lipoedema (abdomen, etc.).

Lipoedema is almost always symmetric This means that both legs and / or both arms are affected. Side differences are extremely rare.

The lipedema of the legs may also include the buttocks evenly. The feet are however left out. Similarly, the hands are cut out in a lipoedema on the arms. At the transition between the lipoedema and the hands or feet, a so-called “grease collar“Stand out.

Lipoedema may or may not be associated with overall obesity. Often one observes it however even with very slim women, So lipoedema has nothing to do with body constitution!

The Lipoedema swelling is usually soft, It can hardly be reduced by raising the legs (or arms). This is a difference to the edema (water accumulation in the tissue).

In the folds of skin, which arise through the adipose tissue multiplication, can itself Inflammation and infections form.

In the subcutaneous fatty tissue of the affected extremities are often small knot palpablethat can get bigger in the process. In late stages, so-called Worms (fat lobes).

Lipoedema: pain and bruising

Important lipoedema symptoms are also one Tension and pain in the affected areas of the body, for example in the legs. These can be feel heavy and especially after a long standing and walking hurt. Patients also often report touch and pressure pains. Especially in late stages of the disease, lipoedema pain can be so severe that sufferers are less agile and are significantly restricted in everyday life.

One of the lipoedema symptoms is one increased tendency to bruising: Even lighter injuries cause a “bruise”. But there is no coagulation disorder in the whole body. Presumably, the vessels in the affected tissue are more vulnerable. This causes bruising faster than with other people.

The lipoedema progresses

Lipoedema is a progressive disease. This means, the lipoedema symptoms increase untreated: Thus, a first grade, mild lipoedema may develop into advanced lipoedema with large adipose tissue proliferation.

That’s for many sufferers mentally very stressful, Many patients feel increasingly uncomfortable in and with their bodies. Self-esteem suffers, and anxiety and depression can develop. Above all, if the diagnosis is made late and those affected are wrongly diagnosed as (self-inflicted) overweight, that can put a strain on the psyche. The usually lengthy treatment can also help – especially if it does not lead to success.

Differences to other diseases

Often the symptoms of lipedema are mistaken for the signs of other illnesses. For example, a strong overweight (obesity = obesity) can cause a similar symptoms. The same applies to lymphoedema and lipohypertrophy: Lymphoedema develops when fluid and protein accumulate in the tissue, because the removal via the lymphatic system is disturbed. Like the lipoedema, lipohypertrophy is caused by a local increase in adipose tissue. But she never causes pain to those affected.

The following table lists the main differences between lipoedema, lymphedema, lipohypertrophy, and obesity:

lipoedema	lymphedema	lipohypertrophy	obesity
Symmetrical increase of adipose tissue on both legs and possibly on the buttocks (and / or on both arms). Feet and hands are left out. Otherwise, the person concerned is usually slim. Thus, the body appears clearly disproportionate (disproportion).	Unbalanced (unilateral) proliferation of adipose tissue. If a leg or arm is affected, then usually the foot / hand. Body looks slightly disproportionate.	Symmetrical increase of adipose tissue on both legs (and buttocks). Body looks clearly disproportionate.	More or less everywhere on the body excess fat pads. Normal or slightly uneven body proportions.
With water retention in the tissue (edema).	With water retention in the tissue (edema).	No water retention in the tissue (edema).	Water retention in the tissue (edema) possible.
Pressure pain.	No pressure pain.	No pressure pain.	No pressure pain.
Significant tendency to bruises.	No tendency to bruising.	Tendency to bruising possible.	No tendency to bruising.

The individual clinical pictures can also occur in combination. For example, if someone is suffering from lipoedema and obesity at the same time, both symptoms mix.

Lipoedema: treatment

Lipoedema treatment is difficult and controversial. To date, the cause of the disease is unknown. The lipoedema can therefore not be treated causally and not cured. However, the course of the disease can be alleviated – by conservative and / or surgical therapy methods.

The The goal of lipedema treatmentis to relieve the symptoms of the patient, especially the pain. In addition, it should be prevented that the disease progresses and complications occur. In addition, all factors should be reduced, which favor a lipoedema. These include above all:

• overweight
• Water retention in the tissue (edema)
• mental stress

Lipoedema: physiotherapy

The conservative treatment of lipedema is based on physiotherapeutic measures. The umbrella term for this treatment method is “complex physical decongestive therapy“(KPE). It is particularly promising for a concurrent lymphedema (lipolymphoedema).

The therapy includes a manual lymph drainage in the form of scoop, turn and pump handles. This is done by the therapist first, away from the lipoedema on the trunk, to create a suction, and then in the area of ​​the lipoedema itself. Initially, manual lymphatic drainage can be scheduled for one hour daily for three to four weeks.

Immediately following each session, the affected area should be wrapped or a compression stocking should be applied. These compression treatment Although reduces lipoedema only slightly. However, it may slow the progression and prevent lymphedema from lipoedema.

There are also other physiotherapeutic procedures that can be helpful in lipoedema. This includes about the Shock Wave Therapy, It improves blood circulation in the tissue. Some patients also receive a so-called intermittent pneumatic compression, During this process, alternately low and high pressures are exerted alternately on the affected area.

Patients with severe lipedema are often recommended to undergo inpatient physiotherapy.

Massage and elevation of the legs usually does not improve the lipoedema symptoms. They also rarely prevent the progression of the disease.

Lipoedema: Sport supports the therapy

If you have lipoedema, you should exercise regularly and exercise. While this can not reduce the number of fat cells, it still makes sense: physical activity keeps you mobile and mobile – many patients avoid any activity due to pain. Movement therapy is especially important when lipoedema is associated with severe obesity.

Tip: Choose a sport with low risk of injury and smooth, smooth movements (no slow braking). Swimming, water aerobics, fast walking and cycling are suitable.

Lipoedema: Diet has little direct influence

Many people think lipoedema is simply the result of excessive weight gain and can be eliminated by losing weight. But that’s not correct. Therefore, a strict diet does not help very much against lipedema and can even be harmful: if you focus on saving calories, even if it does not make lipoedema disappear, it can negatively affect the patient’s mental health and mental health. Experts even suggest that a number of lipedema patients suffer from an eating disorder (such as anorexia).

There are also no special lipoedema dietwhich helps to prevent symmetrical fatty tissue proliferation on the legs and / or arms. Lipoedema patients should simply pay attention to a balanced, healthy diet. This generally promotes good health. In addition, if you are overweight, a healthy diet can help to reduce excess kilos. Patients can get tips from the nutritionist.

Further conservative measures

Also belongs to the lipoedema treatment skin care, It prevents inflammation and infections in the affected skin area. Therefore, you should always cream the skin well, so that it does not dry and cracked. Small injuries should be treated immediately so that they do not inflame or infect.

Psychological support of the patient is an important part of holistic lipoedema therapy. Many patients suffer from depression, anxiety and / or eating disorders. The sufferers should necessarily psychological help receive.

Lipoedema: Liposuction

Lipoedema can be surgically treated by liposuction. Diseased subcutaneous fatty tissue is permanently removed. The procedure is performed, for example, if the symptoms persist or even increase despite conservative lipoedema therapy (such as physiotherapy). Although subcutaneous fatty tissue proliferates despite consistent conservative treatment, liposuction is indicated.

Liposuction is not a way to get rid of excess weight when you are overweight!

Liposuction can improve the symptoms of most patients over many years. In particular, the pain and the bruise inclination can be reduced by the procedure – as well as the extent of the affected extremities. In addition, many sufferers do not need conservative measures (eg, compression) after liposuction, or at least to a lesser extent than before.

With pronounced lipoedema and lipolymph edema, large, sagging tissue sacs may remain after decongestive therapy and weight reduction. Then a special plastic surgery (Dermolipektomie) may be more useful than a liposuction.

Sequence of liposuction

Liposuction should only be performed at specialized centers – either outpatient or inpatient. The physician uses a cannula to transfer larger amounts of a special irrigation fluid into the lipoedema tissue. This so-called tumescent solution contains, among other things, a local anesthetic, saline and adrenaline. It is then sucked out of the tissue together with a lot of fat. This technique is also called “moist” liposuction. It can be assisted by a jet of water or vibration:

• Water Jet Assisted Liposuction (WAL): After administration of the Tumszens solution, the fat is dissolved out with a fan-shaped jet of water and aspirated.
• Power assisted liposuction: The suction cannula is set in vibration. Since fat cells are more sluggish than blood vessels and nerve cells, they are loosened and aspirated.

After the procedure, patients should recover quickly (mobilization) and receive physical therapy. This way you can avoid or reduce swelling that often occurs after liposuction.

A maximum of around five liters can be removed in one session. In severe cases, therefore, several sessions are usually necessary to significantly reduce the lipoedema.

As with any surgical procedure are also in a liposuction (severe) side effects possible. Among other things, the lymphatic system can be injured. As a result, secondary lymphedema can develop.

Not always the liposuction is paid by the health insurance companies. Then patients have to pay for the costs themselves.

Lipoedema: causes and risk factors

Lipoedema develops when subcutaneous fat tissue locally increases: The fat cells enlarge and multiply. In addition, more or less water is stored. This is a progressive process. Thus, the affected area of ​​the body can increase in size very much over time.

The exact lipoedema causes are unknown. Experts have but some assumptions. For example, the hormone system as well as a genetic predisposition seem to be crucial in the development of lipoedema. At the same time, there is no evidence to suggest that a poor diet, lack of exercise or other “wrongdoing” can cause lipedema.

hormones

The importance of (female) hormones in the development of lipoedema suggests that almost exclusively women are affected, especially in phases of hormonal changes. That would be during and after puberty, during pregnancy and during menopause. Especially the hormone estrogen plays an important role in the development of lipoedema. Namely, fat cells react to estrogen through special docking sites (receptors) on their surface.

In the few men with lipoedema can always prove a hormonal disorder. This also indicates that hormones are involved in lipoedema. For example, some of the affected men have liver disease that interferes with hormone metabolism (for example, cirrhosis of the liver in chronic alcohol use). Others suffer from a lack of testosterone or growth hormone or receive hormone therapy (such as prostate cancer).

The hormonal changes and disorders lead to imbalances in the internal weight control of the body, the nerves in the fatty tissue and also to inflammatory processes.

Genetic predisposition

Often, several members of a family suffer from lipoedema. This indicates a genetic predisposition. Presumably, genes important for vessel development play a role in the development of lipedema.

vascular damage

In addition to adipose tissue disorder, inflammatory dysfunction of the vessels in the subcutaneous tissue of patients is suspected in lipoedema. The vessels in the affected area should have “leaks” that promote the passage of fluid into the tissue. This also makes them more prone to bruising and can contribute to the pain.

Lipoedema: examinations and diagnosis

The diagnosis of lipedema is often not easy. There are many other diseases that cause similar symptoms. In addition, some doctors are little familiar with the disease lipedema. Therefore, some people do not diagnose lipoedema or diagnose it at an advanced stage. If you suspect lipoedema, you should contact a specialist. These include dermatologists (dermatologists) as well as vein and lymph specialists (phlebologists and lymphologists).

Doctor-patient conversation

First, the doctor will talk in detail with you to raise your medical history (anamnesis). Possible questions of the doctor are:

• Do you have pain, a feeling of tension or heaviness in the affected area of ​​the body?
• Are you prone to bruising in the affected area of ​​the body?
• Since when do you have these complaints? Have they changed over time?
• Do you take hormone supplements (men and women) or are you in a phase of hormonal changes (women, such as menopause)?
• What have you done so far against the proliferation of adipose tissue (weight loss tests, sports, etc.)
• Are similar cases known in your family?

The doctor may also ask you about your mental state, such as whether you have anxiety, eating disorders, or depression. Answer the doctor honestly. This makes the diagnosis easier and helps the doctor to choose the right treatment for you.

Physical examination

Together with the findings from the conversation, the physician usually needs a targeted physical examination in order to be able to make the lipedema diagnosis. Already the symmetrical fat tissue proliferation at the extremities with otherwise slim hull provides a clear indication.

In addition, in advanced lipoedema (arms, legs) there is a kind of “fat collar” over the hands or ankles. This is followed by a so-called change in the caliber from the thick arms / legs to the relatively narrow hands / feet which are left open by the increase in fetal tissue. However, this does not apply if, in addition to the lipedema, there is still lymphedema (lipolymph edema).

To distinguish between lipoedema and lymphedema, such as on the leg, the so-called Stemmer sign, It is positive if no skin fold can be lifted off the forefoot. In lymphedema this is not possible due to the tension caused by the embedded lymph. With lipoedema, on the other hand, the skin on the foot (on the hand) can be lifted off a bit. But beware: As there are also mixed forms of lip and lymph edema, a negative Stemmer sign does not exclude lipoedema!

The doctor carefully inspects the affected area and pays attention skin lesions, For example, he checks whether the skin in the affected body of the body is taut and whether there are any knots in the subcutaneous tissue. The affected area is usually very painful and easily vulnerable. In addition, in lipoedema, inflammation and infection may form, especially in skin folds.

Finally, the doctor notes exactly where on your body which changes are noticeable and how pronounced they are. In follow-up examinations, he can see how the disease develops in you. For example, the doctor will also measure your weight and height, calculate your body mass index (BMI), and determine the size and volume of your arms and legs. It is also useful to calculate the ratio of waist circumference to hip circumference or body size.

Lipoedema classification

Lipoedema can be classified according to different criteria:

After the location of the lipedema Physicians distinguish the thigh type, full-body type, lower leg type, upper arm type, all-arm type and lower arm type. Many patients also have mixed pictures (such as thigh and upper arm type).

According to structure and surface of the skin (Morphology), the following three lipoedema stages are distinguished:

• Lipoedema stage 1: smooth skin surface, uniformly thickened and homogeneous subcutaneous tissue
• Lipoedema stage 2: uneven, predominantly wavy skin surface; nodular structures in the subcutaneous tissue
• Lipoedema stage 3: marked proliferation in the affected area of ​​the body with overhanging parts of the body (jowls)

At each stage, lymphedema may develop in addition to lipoedema. This is facilitated by factors such as severe overweight (obesity) and lack of exercise.

Imaging and functional examinations

Imaging examinations are not required for lipoedema diagnosis. Experienced examiners, however, can ultrasonographically examine the affected area to assess the size of lipedema and vessel condition.

With special tests, the doctor can assess your lymphatic system more accurately. These include so-called (functional) lymphoscintigraphy and indirect lymphangiography. This can be used to diagnose or exclude lymphedema.

Only in isolated cases magnetic resonance imaging (MRI) or computed tomography (CT) is performed in patients with lipedema.

Alternative diagnoses

As mentioned in the Symptoms section, there are a number of disorders that are similar to lipoedema. The distinction is not always easy. A specialist can therefore best distinguish between lipoedema and possible other causes of your condition. These differential diagnoses include:

• strong overweight (obesity)
• lymphedema
• lipohypertrophy
• Lipoma (circumscribed, encapsulated and harmless fat swelling)
• Phleboedema (an edema caused by venous insufficiency)
• other forms of edema such as myxedema (edema-like swelling of the subcutaneous tissue due to a thyroid disorder)
• Dercum’s disease (obesity dolorosa)
• Madelung syndrome (fatty tissue proliferation in the neck and neck area, around the shoulder region or in the pelvic area)
• Fibromyalgia (chronic disease of the rheumatic type with severe muscle pain)

Lipoedema: disease course and prognosis

Lipoedema is a chronic, progressive disease. Their course can not be generally predicted. He is significantly dependent on additional existing diseases such as obesity.

If lipedema has been detected, it should be treated in any case. So you can prevent it from progressing further and the quality of life of the affected (further) restricts. According to current knowledge, a lipoedema cure is not possible. With modern therapy methods, however, the symptoms of the disease can be significantly alleviated and the fat distribution disorder alleviated in many patients.

In contrast to other diseases such as vascular changes or other forms of edema increases lipoedema but not the risk of chronic wounds (ulcers) or blood clots (thrombosis).

Additional information:

Book recommendations:

• Lipoedema: recognize in time and treat properly. Effective help without surgery (Dr. med Thomas Weiss, 2015, southwest)

guidelines:

• S1 Guideline “Lipoedema”, German Society for Phlebology (as of 2015)