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Lymphoedema is a well-known concern for cancer survivors. A crucial issue in lymphoedema is that we cannot predict who will be affected, and onset can occur many years after initial cancer treatment. The variability of time between cancer treatment and lymphoedema onset is an unexplained mystery. Retrospective cohort studies have investigated the risk factors for lymphoedema development, with extensive surgery and the combination of radiation and surgery identified as common high-risk factors. However, these studies could not predict lymphoedema risk in each individual patient in the early stages, nor could they explain the timing of onset. The study of anatomy is one promising tool to help shed light on the pathophysiology of lymphoedema. While the lymphatic system is the area least investigated in the field of anatomical science, some studies have described anatomical changes in the lymphatic system after lymph node dissection. Clinical imaging studies in lymphangiography, lymphoscintigraphy and indocyanine green (ICG) fluorescent lymphography have reported post-operative anatomical changes in the lymphatic system, including dermal backflow, lymphangiogenesis and creation of alternative pathways via the deep and torso lymphatics, demonstrating that such dynamic anatomical changes contribute to the maintenance of lymphatic drainage pathways. This article presents a descriptive review of the anatomical and imaging studies of the lymphatic system in the normal and post-operative conditions and attempts to answer the questions of why some people develop lymphoedema after cancer and some do not, and what causes the variability in lymphoedema onset timing.

<p>Das Lipödem ist eine progrediente Erkrankung, die immer mehr Frauen betrifft und zunehmend bewusster als Krankheit wahrgenommen wird. Sie ist gekennzeichnet durch eine Umfangsvermehrung durch Fettgewebsvermehrung der Extremitäten und kann im Verlauf zu Ödemen führen. Im Gegensatz dazu ist das Lymphödem durch eine umschriebene Lymphabflussstörung definiert, die zur Bindegewebsfibrose des umliegenden Gewebes führen kann. Während das Lipödem als klinische Diagnose gesichert werden kann und eine bildgebende Diagnostik meist nur zum Ausschluss von Begleiterkrankungen eingesetzt werden kann, gibt es bei einem Lymphödem die Möglichkeit zur Darstellung einer Lymphabflussstörung durch bildgebende Verfahren. Eine Ultraschalluntersuchung ist als Basisdiagnostik zur Darstellung der eingelagerten interstitiellen Flüssigkeit sowohl beim Lip- als auch Lymphödem indiziert. Der Goldstandard zur Darstellung einer Lymphabflussstörung ist die Lymphszintigrafie, die auch in Kombination mit einer Computertomografie durchgeführt werden kann. Eine weitere dynamische Untersuchung ist die Indocyaningrün (ICG)-Lymphografie, deren Durchführung immer mehr an Bedeutung gewinnt, weil sie auch intraoperativ genutzt werden kann. Eine Magnetresonanz (MR)-Lymphografie zur 3-dimensionalen Darstellung eines Lymphödems und einer Lymphabflussstörung kann eine sinnvolle Ergänzung zur Therapie eines Lip- bzw. Lymphödems sein. Zur Therapie des Lip- und Lymphödems sollte stets eine Kombination aus konservativen und operativen Maßnahmen angestrebt werden. Während die Liposuktion und andere resezierende Verfahren Möglichkeiten zur Beschwerdelinderung bei bestehendem Lipödem oder fortgeschrittenem Lymphödem bieten, stellen die neuen rekonstruktiven Verfahren, wie beispielsweise die Lymphknotentransplantation und die Schaffung von lymphovenösen Anastomosen, vielversprechende, moderne Methoden zur Behandlung eines Lymphödems dar. Durch die Schaffung neuer Lymphabflusswege können Patienten mit einem Lymphödem auf eine langfristige Volumenreduktion der betroffenen Extremität oder Körperstelle und der damit verbundenen Symptomlinderung und Verbesserung der Lebensqualität hoffen.</p>

Lipedema is a frequently unrecognized and misdiagnosed disorder of the fatty tissue of extremities and hips, which affects almost purely women. The beginning of the disease usually occurs with hormonal changes, such as puberty, pregnancy, or menopause. Women suffer from pain, easy bruising, and disfigurement, which may lead to early immobility and social stress. Accurate diagnosis and treatment are essential. The differentiation between obesity and lipedema is difficult, as these two different entities often occur together. Other differential diagnoses are lymphedema, benign lipohypertrophy, and Dercum’s disease. A therapy targeting the underlying cause of lipedema is not available because the exact etiology of the disorder is not clarified yet. Decongestive physical therapy is the basic conservative treatment, which is usually necessary lifelong. However, liposuction has led to a paradigm shift in the treatment of lipedema. The purposes of this article are to describe the symptoms and treatment options of the still fairly unknown disease Lipedema and to show the distinctions to its differential diagnoses.

BACKGROUND: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that usually affects the lower extremities of women. Also known as "two-body syndrome," the fat accumulations in lipedema are unsightly and painful. The disorder is well-known in Europe but is largely unrecognized and underdiagnosed in the United States. OBJECTIVE: To hold the First International Consensus Conference on Lipedema with the purpose of reviewing current European guidelines and the literature regarding the long-term benefits that have been reported to occur after lymph-sparing liposuction for lipedema using tumescent local anesthesia. METHODS: International experts on liposuction for lipedema were convened as part of the First International Congress on Lipedema in Vienna, Austria, June 9 to 10, 2017. RESULTS: Multiple studies from Germany have reported long-term benefits for as long as 8 years after liposuction for lipedema using tumescent local anesthesia. CONCLUSION: Lymph-sparing liposuction using tumescent local anesthesia is currently the only effective treatment for lipedema.

Lipedema is a disease with high prevalence but low recognition. It is often misdiagnosed and underdiagnosed. Obesity and lymphoedema are the most common differential diagnoses and can also coexist in patient with lipedema. Its broad range of presentation and fat distribution types contribute to this confusion. It is likely that lipedema symptom variations and presentation forms are often associated with hormonal variations, chronic low-grade systemic inflammation, and wide polygenic variations. This paper presents a theory regarding the clinical evolution of lipedema clinical and its involvement with other diseases, suggesting a three-phase approach for treatment.

Abstract The four previous articles in this series addressed the myths and facts surrounding lipoedema. We have shown that there is no scientific evidence at all for the key statements made about lipoedema – which are published time and time again. The main result of this “misunderstanding” of lipoedema is a therapeutic concept that misses the mark. The patient’s real problems are overlooked. The national and especially the international response to the series, which can be read in both German and English, has been immense and has exceeded all our expectations. The numerous reactions to our articles make it clear that in other countries, too, the fallacies regarding lipoedema have led to an increasing discrepancy between the experience of healthcare workers and the perspective of patients and self-help groups, based on misinformation mostly generated by the medical profession. Parts 1 to 4 in this series of articles on the myths surrounding lipoedema have made it clear that we have to radically change the view of lipoedema that has been held for decades. Changing our perspective means getting away from the idea of “oedema in lipoedema” – and hence away from the dogma that decongestion is absolutely necessary – and towards the actual problems faced by our patients with lipoedema. Such a paradigm shift in a disease that has been described in the same way for decades cannot be left to individuals but must be put on a much broader footing. For this reason, the lead author of this series of articles invited renowned lipoedema experts from various European countries to discussions on the subject. Experts from seven different countries took part in the two European Lipoedema Forums, with the goal of establishing a consensus. The consensus reflects the experts’ shared view on the disease, having scrutinized the available literature, and having taken into account the many years of clinical practice with this particular patient group. Appropriate to the clinical complexity of lipoedema, participants from different specialties provided an interdisciplinary approach. Nearly all of the participants in the European Lipoedema Forum had already published work on lipoedema, had been involved in drawing up their national lipoedema guidelines, or were on the executive board of their respective specialty society. In this fifth and final part of our series on lipoedema, we will summarise the relevant findings of this consensus, emphasising the treatment of lipoedema as we now recommend it. As the next step, the actual consensus paper “European Best Practice of Lipoedema” will be issued as an international publication. Instead of looking at the treatment of oedema, the consensus paper will focus on treatment of the soft tissue pain, as well as the psychological vulnerability of patients with lipoedema. The relationship between pain perception and the patient’s mental health is recognised and dealt with specifically. The consensus also addresses the problem of self-acceptance, and this plays a prominent role in the new therapeutic concept. The treatment of obesity provides a further pillar of treatment. Obesity is recognised as being the most common comorbid condition by far and an important trigger of lipoedema. Bariatric surgery should therefore also be considered for patients with lipoedema who are morbidly obese. The expert group upgraded the importance of compression therapy and appropriate physical activity, as the demonstrated anti-inflammatory effects directly improve the patients’ symptoms. Patients will be provided with tools for personalised self-management in order to sustain sucessful treatment. Should conservative therapy fail to improve the symptoms, liposuction may be considered in strictly defined circumstances. The change in the view of lipoedema that we describe here brings the patients’ actual symptoms to the forefront. This approach allows us to focus on more comprehensive treatment that is not only more effective but also more sustainable than focusing on the removal of non-existent oedema. , Zusammenfassung Die Mythen und Fakten des Lipödems waren das Thema der vergangenen 4 Teile dieser Artikelserie. Wir konnten zeigen, dass für die zentralen – und immer wieder publizierten – Statements zum Lipödem keinerlei wissenschaftliche Evidenz vorliegt. Wesentliche Folge dieses „Fehlverständnisses“ der Erkrankung Lipödem ist ein Therapiekonzept, welches an den tatsächlichen Beschwerden der Patientinnen weitgehend vorbeigeht. Der nationale, aber vor allem auch der internationale Zuspruch, der auch in Englisch zu lesenden Reihe, war immens und übertraf all unsere Erwartungen. Die zahlreichen Reaktionen auf unsere Artikelserie machten eines deutlich: Auch in anderen Ländern führen die Stilblüten des Lipödems zu einer zunehmenden Diskrepanz zwischen den Erfahrungen der Behandler und der durch – meist ärztlich verursachten – Fehlinformation geleiteten Perspektive der Patientinnen und Selbsthilfegruppen. Die Teile 1 bis 4 der Artikelserie über die Mythen des Lipödems haben deutlich gemacht, dass wir diese seit Jahrzehnten tradierte Perspektive auf die Erkrankung Lipödem verändern müssen. Veränderung der Perspektive heißt: Weg vom „Ödem im Lipödem“, damit auch weg vom Dogma der notwendigen „Entstauung“ und hin zu den tatsächlichen Beschwerden unserer Lipödem-Patientinnen. Ein solcher Paradigmenwechsel eines seit Jahrzehnten auf immer gleiche Weise beschriebenen Krankheitsbildes kann nicht Aufgabe Einzelner sein, sondern muss auf breite Füße gestellt werden. Aus diesem Grund hat der ärztliche Erstautor dieser Artikelreihe renommierte Lipödem-Experten aus verschiedenen europäischen Ländern zu einer Diskussion über das Lipödem eingeladen. Ziel der beiden „European Lipoedema-Foren“, an denen Experten aus 7 Ländern teilnahmen, war die Erstellung eines Konsensus. Dieser Konsensus spiegelt unter Sichtung der zur Verfügung stehenden wissenschaftlichen Literatur – bei gleichzeitiger Berücksichtigung der jeweils langjährigen klinischen Arbeit mit diesen Patientinnen – die gemeinsame Sicht der beteiligten europäischen Experten auf diese Erkrankung wider. Der Komplexität des Krankheitsbildes Lipödem angemessen war auch die Struktur der Teilnehmer interdisziplinär. Nahezu alle Teilnehmer des European Lipoedema-Forum haben in der Vergangenheit entweder über das Lipödem publiziert bzw. an ihren nationalen Lipödem-Leitlinien mitgearbeitet oder sind in Vorständen ihrer Fachgesellschaften vertreten. In diesem fünften und letzten Teil unserer Artikelserie über das Lipödem sollen vorab die wesentlichen Ergebnisse dieses Konsensus kurz zusammengefasst werden, wobei der Fokus auf der empfohlenen Therapie des Lipödems liegt. Das eigentliche Konsensus-Papier, „European Best Practice of Lipoedema“, wird dann in einem zweiten Schritt im Rahmen einer internationalen Publikation veröffentlicht. Statt einer Ödem-Behandlung wird im Konsensus-Papier auf die Behandlung des Weichteilschmerzes ebenso fokussiert wie auf die psychische Vulnerabilität der Lipödem-Patientin. Zusammenhänge zwischen der Schmerzwahrnehmung und der psychischen Situation der Patientin werden anerkannt und gezielt behandelt. Hierbei wird auch das Problem der Selbstakzeptanz thematisiert und spielt im neuen Behandlungskonzept eine herausragende Rolle. Eine weitere Therapiesäule stellt die Adipositas-Behandlung dar. Adipositas wird somit als mit Abstand häufigste Begleiterkrankung – und wesentlicher Trigger – des Lipödems akzeptiert. Bei schwer adipösen Lipödem-Patientinnen sollte daher auch die bariatrische Operation erwogen werden. Kompressionstherapie und gezielte Bewegungsaktivität wurden von der Expertengruppe deutlich aufgewertet, da durch die nachgewiesenen antiinflammatorischen Effekte die Beschwerden der Patienten direkt verbessert werden. Durch ein individualisiertes Selbstmanagement werden den Patientinnen Tools mit an die Hand gegeben, die den Therapieerfolg nachhaltig stabilisieren. Sollte die konservative Therapie zu keiner relevanten Beschwerdebesserung führen, kann die Liposuktion unter Einhaltung klar definierter Vorgaben erwogen werden. Die hier beschriebene Veränderung der Perspektive auf das Lipödem stellt die tatsächlichen Beschwerden der Patientinnen in den Fokus. Dies ermöglicht eine umfassendere, damit bessere und auch nachhaltigere Behandlung als die Fokussierung auf ein nie nachgewiesenes Ödem und dessen Entstauung.

Lipomas are defined as a common subcutaneous tumor composed of adipose (fat) cells, often encapsulated by a thin layer of fibrous tissue.[1] In fact, these are the frequently encountered neoplasms by the clinicians. [2] Clinically, they often present in the body's cephalic part, specifically in the head, neck, shoulders, and backs of patients. However, they can less commonly be seen elsewhere, for example, the thighs. The tumors typically lie in the subcutaneous tissues of patients. The masses are often benign, and while the age of onset can vary. There is usually no reason for treatment. They pose no threat to the patient unless they are uncomfortable due to being located on joints or rapidly growing, which is uncommon, as the typical lipoma growth is slow. Lipomas can sometimes, though rare, be associated with certain disorders such as multiple hereditary lipomatosis, Gardner syndrome, adiposis dolorosa, and Madelung disease.[3] [4] Some unconventional forms of lipomas include the following: angiolipoma, chondroid lipoma, lipoblastoma, myolipoma, pleomorphic lipoma/spindle cell lipoma, intramuscular and intermuscular lipoma, lipomatosis of nerve, lipoma of the tendon sheath and joint, lipoma arborescens, multiple symmetric lipomatosis, diffuse lipomatosis, adiposis dolorosa, and hibernoma.

Lipedema is a chronic and progressive disease of adipose tissue caused by abnormal fat accumulation in subcutaneous tissue. Although there is no known cure for lipedema, possible complications can be prevented with conservative and surgical treatments. One of the conservative treatment options is physiotherapy and rehabilitation (PR). When the literature is examined, few studies focusing on the efficacy of PR were found for this patient group. The purpose of this review is to provide a better understanding of the effectiveness of PR applications by compiling existing studies. A bibliographic PubMed search was performed for published studies regarding PR in lipedema management in June 2019 including the last 58 years (1951-2019). Articles were chosen by reading the abstracts and subsequently data were analyzed by reading the entire text through full-text resources. A total of 15 studies met inclusion criteria. Results document how lipedema patients are benefited by PR and the effectiveness of different types of PR programs. The current review also showed that complex decongestive physiotherapy, gait training, hydrotherapy, aerobic exercise, and resistance exercise training each have value in the management of lipedema. The effects of PR for the treatment of lipedema are variable among studies, although overall PR seems to be effective in lipedema management. Although physiotherapy applications have a potentially important role in the management of lipedema, they should be used in combination with other treatment modalities. More studies with higher quality are needed to fully demonstrate the effect and efficacy of PR in lipedema patients.

Lipedema can cause chronic pain and increases patients’ risk for conditions such as lymphedema and venous disease. This author explores how lipedema affects the body, why its effects are disproportionate in the lower body, and how to diagnose and manage the condition.

Obesity is a leading cause of cardiovascular diseases and cancer. Body mass is regulated by the balance between energy uptake and energy expenditure. The etiology of obesity is determined by multiple factors including genetics, nutrient absorption, and inflammation. Lymphatic vasculature is starting to be appreciated as a critical modulator of metabolism and obesity. The primary function of lymphatic vasculature is to maintain interstitial fluid homeostasis. Lymphatic vessels absorb fluids that extravasate from blood vessels and return them to blood circulation. In addition, lymphatic vessels absorb digested lipids from the intestine and regulate inflammation. Hence, lymphatic vessels could be an exciting target for treating obesity. In this article, we will review our current understanding regarding the relationship between lymphatic vasculature and obesity, and highlight some open questions.

Lipedema is a chronic, progressive, painful, increased deposition subcutaneous fat tissue in women with a clear disproportion between the trunk and extremities. Lipedema offen lead to oedema, which are worsened by orthostasis, and hematoma after minor injury. The pathogenesis is unknown and no curative treatment is available. Conservative therapy consisting of lymphatic drainage and compression stockings is often recommended, but is only effective against the edema component. Some patients show a short-term improvement when treated in this way. Permanent reduction of the pathological subcutaneous fat on the legs and arms has become possible by employing advanced liposuction techniques using microcannula technology in local tumescent anaesthesia.

Summary Lipedema is a painful, chronically progressive disease that is characterized by a symmetrical increase in subcutaneous fat with fluid accumulation on the legs and / or arms. Due to ignorance of the clinical picture, the disease is often not recognized or misinterpreted. Correct diagnosis and treatment are important, however, as the prognosis of the disease can be influenced. A causal therapy for lipedema is not known because the exact etiology is not yet fully understood. A hereditary component is suspected on the basis of a family history of the disease. Since lipedema occurs almost exclusively in women and the onset of the disease is often associated with the onset of hormonal changes (puberty, pregnancy, menopause), In addition, the estrogen is assigned a decisive role in the development. In the present work we present an overview of the symptoms and clinical features of lipedema, its differential diagnoses, treatment options and, lastly, the current hypotheses on the pathogenesis of lipedema.

BACKGROUND: Although a large number of adult women worldwide are affected by lipedema, the physiologic conditions triggering onset and progression of this chronic disease remain enigmatic. In the present study, a descriptive epidemiologic situation of postoperative lipedema patients is presented. METHODS: The authors developed an online survey questionnaire for lipedema patients in Germany. The survey was conducted on 209 female patients who had been diagnosed with lipedema and had undergone tumescent liposuction. RESULTS: Most of the participants (average age, 38.5 years) had noticed a first manifestation of the disease at the age of 16. It took a mean of 15 years to accomplish diagnosis. Liposuction led to a significant reduction of pain, swelling, tenderness, and easy bruising as confirmed by the majority of patients. Hypothyroidism [n = 75 (35.9 percent) and depression [n = 48 (23.0 percent)] occurred at a frequency far beyond the average prevalence in the German population. The prevalence of diabetes type 1 [n = 3 (1.4 percent)], and diabetes type 2 [n = 2 (1 percent)] was particularly low among the respondents. Forty-seven of the lipedema patients (approximately 22.5 percent) suffered from a diagnosed migraine. Following liposuction, the frequency and/or intensity of migraine attacks became markedly reduced, as stated by 32 patients (68.1 percent). CONCLUSIONS: Quality of life increases significantly after surgery with a reduction of pain and swelling and decreased tendency to easy bruising. The high prevalence of hypothyroidism in lipedema patients could be related to the frequently observed lipedema-associated obesity. The low prevalence of diabetes, dyslipidemia, and hypertension appears to be a specific characteristic distinguishing lipedema from lifestyle-induced obesity.

Lipedema is a painful fat disease of loose connective tissue usually misdiagnosed as lifestyle-induced obesity that affects ~10% of women of European descent as well as other populations. Lipedema is characterized by symmetric enlargement of the buttocks, hips, and legs due to increased loose connective tissue; arms are also affected in 80% of patients. Lipedema loose connective tissue is characterized by hypertrophic adipocytes, inflammatory cells, and dilated leaky blood and lymphatic vessels. Altered fluid flux through the tissue causes accumulation of fluid, protein, and other constituents in the interstitium resulting in recruitment of inflammatory cells, which in turn stimulates fibrosis and results in difficulty in weight loss. Inflammation and excess interstitial substance may also activate nerve fibers instigating the painful lipedema fat tissue. More research is needed to characterize lipedema loose connective tissue structure in depth, as well as the form and function of blood and lymphatic vessels. Understanding the pathophysiology of the disease will allow healthcare providers to diagnose the disease and develop treatments.

Obesity is a worldwide major public health problem with an alarmingly increasing prevalence over the past 2 decades. The consequences of obesity in the skin are underestimated. In this paper, we review the effect of obesity on the skin, including how increased body mass index affects skin physiology, skin barrier, collagen structure, and wound healing. Obesity also affects sebaceous and sweat glands and causes circulatory and lymphatic changes. Common skin manifestations related to obesity include acanthosis nigricans, acrochordons, keratosis pilaris, striae distensae, cellulite, and plantar hyperkeratosis. Obesity has metabolic effects, such as causing hyperandrogenism and gout, which in turn are associated with cutaneous manifestations. Furthermore, obesity is associated with an increased incidence of bacterial and Candida skin infections, as well as onychomycosis, inflammatory skin diseases, and chronic dermatoses like hidradenitis suppurativa, psoriasis, and rosacea. The association between atopic dermatitis and obesity and the increased risk of skin cancer among obese patients is debatable. Obesity is also related to rare skin conditions and to premature hair graying. As physicians, understanding these clinical signs and the underlying systemic disorders will facilitate earlier diagnoses for better treatment and avoidance of sequelae.

Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.

Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.