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At present, there is no proven cure for lipoedema. Nevertheless, much can be done to help improve symptoms and prevent progression. Many of these improvements can be achieved by patients using self-management techniques. This article describes the range of self-management techniques that community nurses can discuss with patients, including healthy eating, low-impact exercise, compression garments, self-lymphatic drainage, and counselling.

Lipedema is a disorder of adipose tissue that primarily affects females and is often misdiagnosed as obesity or lymphedema. Relatively few studies have defined the precise pathogenesis, epidemiology, and management strategies for this disorder, yet the need to successfully identify this disorder as a unique entity has important implications for proper treatment. In this review, we sought to review and identify information in the existing literature with respect to the epidemiology, pathogenesis, clinical presentation, differential diagnosis, and management strategies for lipedema. The current literature suggests that lipedema appears to be a clinical entity thought to be related to both genetic factors and fat distribution. While distinct from lymphedema and obesity, there are some existing treatments such as complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. Management of lipedema is complex and distinct from lymphedema. The role of newer randomized controlled studies to further explore the management of this clinical entity remains promising.

Lipedema is a poorly understood clinical entity that is frequently under-diagnosed and neglected or else confused with lymphoedema. However, in most cases, diagnosis is simple and does not usually necessitate laboratory examinations. There is an extremely high demand for therapy since the condition causes major morbidity and affects quality of life. The aim of treatment is to reduce patient weight; although weight loss does not affect the morphology of the lower limbs, it optimises patient mobility while reducing related complaints and improving quality of life. Conservative surgical measures, of which tumescent liposuction is the most frequent, provide improvement of certain symptoms. A better understanding of this entity will result in improved therapy.

Women wait decades for an accurate diagnosis of lipoedema. Earlier diagnosis is essential to prevent the condition progressing to lymphoedema, with its risk of life-threatening cellulitis.

The increasing prevalence of obesity causes a major interest in white adipose tissue biology. Adipose tissue cells are surrounded by extracellular matrix proteins whose composition and remodeling is of crucial importance for cell function. The expansion ...

Frequently misdiagnosed as obesity, lipoedema is chronic condition involving an abnormal build-up of fat cells in the legs, thighs and buttocks that cannot be shifted by exercise or dieting. Estimated to affect up to 11% of the female population, the condition is widely unknown by health professionals. This means women typically wait for many years before diagnosis. This allows the condition to progress unchecked, resulting in unnecessary deterioration and the development of associated comorbidities, as well as significant pain and mental anguish. A free, 30-minute Royal College of General Practitioners (RCGP) e-learning course created in partnership with Lipoedema UK aims to rectify this situation by educating nurses, GPs and other health professionals on how to diagnose and manage lipoedema in primary care. This article aims to describe the condition of lipoedema, how to recognise/diagnose it, current treatment options and the findings of a 240-patient survey carried out by Lipoedema UK in 2013 that included documenting the difficulties for patients in obtaining a diagnosis as well as the mental and physical effects of the condition.

Lipedema is a disfiguring disorder with abnormal and progressive deposition of adipose tissue in the hips and lower extremities almost exclusively occurring in women. There is a hereditary tendency and a substantial variability in disease severity. Lipedema is often misdiagnosed as lymphedema or morbid obesity. The etiology and pathogenesis are not understood. Early diagnosis and treatment are critical to minimize physical and psychological morbidity. The diagnosis is usually made by history and clinical examination. Non-invasive imaging techniques such as computed tomography or magnetic resonance can differentiate lipedema from other causes of edematous lower extremities. Lymphoscintigraphy may be helpful in cases which are associated with lymphedema (lipo-lymphedema). Management with manual lymphatic drainage and compression therapy are considered the most appropriate treatment. Use of conventional liposuction is controversial since it may further damage the lymphatic vessels. Newer techniques such as tumescent micro annular laser assisted liposuction and water jet-assisted liposuction have shown some promising results. Variety of other surgical procedures combined with manual lymphatic drainage and tailored post-surgical care are under investigation.

Liposuction surgically removes subcutaneous abdominal tissue (SAT) and has almost no effect on visceral abdominal tissue (VAT) depot. However, some authors suggest that deep layers of SAT are functionally similar to VAT and the amount of deep subcutaneous abdominal adipose tissue is strongly related to insulin resistance in a manner nearly identical to that of visceral adiposity. Moreover, SAT determines leptin secretion which indirectly reflects the level of insulin sensitivity in the body. Thus, the immediate removal of SAT could potentially affect metabolic profile of a patient. The current data are conflicting and cannot bring a clear evidence suggesting that liposuction itself results in important metabolic outcomes and, on the other hand, cannot exclude such a possibility. This review summarizes the liposuction-induced metabolic changes with regard to release of major adipokines and insulin sensitivity.

During the last 20 years a deeper understanding of the lymphatic circulatory system, lymph formation and composition has emerged. This review will examine the current knowledge on the organization of the lymphatic vascular tree, the formation of lymph from the extracellular fluid, lymph circulation and the lymph proteomic composition during physiological and pathological conditions. Formation of the lymph fluid is dependent on pressure gradients in the capillary beds and the composition of the endothelial cell glycocalyx, which acts as a molecular sieve. Fluid propulsion toward the draining node is dependent on the intrinsic pumping mechanism of the lymphangions and their unidirectional valves. The lymph ‘omics’ composition is dependent on the ultrafiltration of plasma proteins as well as proteins and molecules derived from the metabolic and catabolic activities of each parenchymal organ from which the lymph drains. Altogether, these new insights have brought about a new awareness of the importance of the lymphatic system in human physiology and pathology.

Background: Lipedema is a painful, genetically induced, abnormal deposition of subcutaneous fat in the extremities of women. The pathogenesis is unknown. Also unknown is the number of women affected in Germany. This study presents the epidemiology of the disease. There are currently two treatment options available: Complex physical decongestive therapy and liposuction. Liposuction is the only method that removes fat permanently. An additional study proves its effectiveness and highlights its vital role as part of a comprehensive treatment concept.

Lipedema is a common, but often underdiagnosed masquerading disease of obesity, which almost exclusively affects females. There are many debates regarding the diagnosis as well as the treatment strategies of the disease. The clinical diagnosis is relatively simple, however, knowledge regarding the pathomechanism is less than limited and curative therapy does not exist at all demanding an urgent need for extensive research. According to our hypothesis, lipedema is an estrogen-regulated polygenetic disease, which manifests in parallel with feminine hormonal changes and leads to vasculo- and lymphangiopathy. Inflammation of the peripheral nerves and sympathetic innervation abnormalities of the subcutaneous adipose tissue also involving estrogen may be responsible for neuropathy. Adipocyte hyperproliferation is likely to be a secondary phenomenon maintaining a vicious cycle. Herein, the relevant articles are reviewed from 1913 until now and discussed in context of the most likely mechanisms leading to the disease, which could serve as a starting point for further research.

Lipedema is a common, but often underdiagnosed masquerading disease of obesity, which almost exclusively affects females. There are many debates regarding the diagnosis as well as the treatment strategies of the disease. The clinical diagnosis is relatively simple, however, knowledge regarding the pathomechanism is less than limited and curative therapy does not exist at all demanding an urgent need for extensive research. According to our hypothesis, lipedema is an estrogen-regulated polygenetic disease, which manifests in parallel with feminine hormonal changes and leads to vasculo- and lymphangiopathy. Inflammation of the peripheral nerves and sympathetic innervation abnormalities of the subcutaneous adipose tissue also involving estrogen may be responsible for neuropathy. Adipocyte hyperproliferation is likely to be a secondary phenomenon maintaining a vicious cycle. Herein, the relevant articles are reviewed from 1913 until now and discussed in context of the most likely mechanisms leading to the disease, which could serve as a starting point for further research.

Compression therapy is the mainstay of treatment in the management of lymphoedema and lipoedema. However, due to variance in the location, severity and type of the condition, patients often have to compromise on garments to ensure that the affected area of oedema is controlled. This article discusses the use of Veni compression shorts (Haddenham Healthcare) and Capri garments as an alternative treatment option to full-leg compression garments. The article explains treatment areas and conditions where the application of these garments will enhance care-for example, for trunkal swelling-and where compression may not generally be required-for example, in the feet.

In many respects, lipedema of the arms and legs is still an underresearched disease within the lymphatic spectrum. It is clear that clinical symptoms frequently include symmetrical fat distribution in the arms and legs and pathognomonic tenderness in female family members. However, 75 years after the first descriptions provided by Allen and Hines, we still lack pathological evidence that would provide more insight than that offered by the theses proposed by Marsch and Brauer. We also lack information about hormonal influence on hyperplastic fatty tissue and the causes of obviously increased lymph formation in the fatty tissue in patients with lipohyperplasia dolorosa. Much more is known about the effects of combined decongestive therapy, which has been used since the 1960s. Moreover, since 1997, surgery has been used to successfully treat this disease presentation. The success rate in long-term observation (15 years) is 97%.

Lipedema is a chronic, incurable, often progressive affliction that occasionally causes significant morbidity. Initially, patients develop a disproportionate increase of body fat in the legs, buttocks and/or arms. Dieting and physical exercise have only limited effect on this disproportionate body fat distribution. The legs may be sensitive and are prone to bruising after only mild trauma. This can deteriorate into severe pain and reduced mobility, ultimately leading to a limitation of activity and social participation. As a result, lipedema patients may often be diagnosed with obesity. Dietary measures generally affect the obesity component but have little effect on the disproportionate body fat distribution. Because lipedema contributes to an increased BMI, even in non-­‐obese patients, a connection between lipedema and excessive calorie-­‐intake or obesity is often incorrectly assumed. In addition to physical problems, lipedema can also lead to psychoso-­‐ cial problems. These are often caused by the failure of consulting professionals to recognize or acknowledge the condition, or because (incorrect) recommendations for weight loss and physical exercise do not contribute to improvements in the complaints. Therefore, it is important to recognize lipedema early so that its accompanying symptoms can be acknowl-­‐ edged at an early stage and be incorporated into an integrated treatment. Little consistent information regarding the diagnosis or treatment of lipedema is found in the literature. Therefore, the goal of this directive is to attempt to establish a consensus for the diagnosis of lipedema and to discuss its symptoms and influencing factors, as well as its effects on activity and social limitations, as these negatively influence the life of the patient.

Leg swelling is an extremely frequent symptom with a broad variety of largely differing causes. The most important mechanisms behind the symptom include venous and lymphatic pathology, volume overload, increased capillary permeability, and lowered oncotic pressure. Therefore, the most frequent diseases associated with leg swelling are deep vein thrombosis and chronic venous insufficiency, primary or secondary lymphedema, cardiac failure, hypoproteinemia due to liver or renal failure, idiopathic cyclic edema, and drug-induced edema. Lipedema as a misnomer represents an important differential diagnosis. History and physical examination, when based on a sound knowledge of the diseases of interest, enable a conclusive diagnosis in most cases. Additional test are required in only a minority of patients. The present review discusses pathophysiology and clinical features of the most prevalent types of leg swelling. Finally, a brief guide to differential diagnosis is given.