Lipoedema
Lipoedema is a chronic, progressive disorder that is characterized by abnormal distribution of adipose tissue. This results in disproportion between extremities and trunk. The disproportion is caused by a localised, symmetrical increase in subcutaneous adipose tissue, typically in the lower extremities, less common also in the upper extremities. Compression wear is one very important element in the treatment of lipoedema.
Are you constantly gaining weight in both legs, buttock and/or arms that won't go away even with the strictest diet?
Do the affected areas bruise easily, feel softer and cooler than unaffected areas, and are extremely sensitive to touch?
If so, you might have developed lipoedema. Read here what other signs could indicate lipoedema, why compression can be helpful in treatment of lipoedema and what other treatment options exist.
What is lipoedema?
Big legs, protruding buttocks – often, lipoedema is wrongly judged as being overweight or obese.
But lipoedema has nothing to do with being overweight. Lipoedema is the result of a pathological build-up of fat cells in the extremities. Typically, it affects the legs. Since lipoedema occurs almost exclusively in women, experts assume hormonal causes.
Despite a conscious diet and exercise, the affected women typically gain weight in their legs and/or, less commonly, arms. The increased accumulation of fat cells cannot be reduced by calorie reduction.
There is no exhaustive research on lipoedema yet. One thing is certain though: This chronic disease is not caused by improper nutrition or excessive food intake. Experts presume a genetic predisposition as well as hormonal triggers.
Lipoedema often starts during puberty. However, oral contraceptive use, pregnancy, and menopause also seem to be triggers. In men, lipoedema-like changes have only been described in the context of hormonally active therapeutic agents, pronounced hormone imbalances (for example, hypogonadism), or liver cirrhosis.
Types of lipoedema
Lipoedema consists of 5 major types, with types 1 to 3 being the most common. It is important to note that individual patients can present with a mixture of types:
- Type 1: pelvis, buttocks, and hips
- Type 2: buttocks to knees, with formation of folds of fat around the inner side of the knees
- Type 3: buttocks to ankles
- Type 4: arms
- Type 5: lower legs
What are the signs and symptoms of lipoedema?
- Considerable tissue enlargement; usually bilateral and symmetrical without involvement of the hands and feet. The pattern of affected areas may vary from patient to patient. It most commonly affects the legs, thighs, hips, and/or buttocks, but it can also affect the arms.
- Pain and extreme sensitivity/tenderness to touch and pressure in the affected areas.
- Swelling and feeling of heaviness in the affected limbs.
- Limited mobility, muscle weakness.
- Cuffing or “braceleting” at the ankles/wrists: The tissue enlargement stops abruptly at the ankles or wrists so that there is a “step” before the feet or hands which are usually unaffected.
- In lower-limb lipoedema, loss of the concave spaces on either side of the Achilles tendon.
- Tendency to easily bruise: May occur anywhere in areas affected by lipoedema without any apparent cause.
- Altered skin appearance, temperature, and texture: Softer and cooler skin in comparison to unaffected areas; texture of orange peel or with larger dimples.
- Abnormal gait, limited mobility, and muscle weakness.
- Stemmer’s sign is negative. This means that a fold of skin can be pinched and lifted up at the base of the second toe or at the base of the middle finger.
- Pitting oedema (in patients with lipoedema or lipo-lymphoedema and/or CVI): Usually absent in the early stages; indicates the presence of excess interstitial fluid.
The stages of lipoedema
Experts divide lipoedema into three stages. Symptoms of lipoedema can vary greatly from person to person – not all patients, for example, reach stage three.
Stage I: The skin appears smooth. If pressed on, uniformly thickened subcutaneous tissue with soft consistency.
Stage II: The skin shows an irregular texture that resembles the skin of an orange. Subcutaneous nodules that vary in size are palpable.
Stage III: The volume increase of the subcutaneous fat tissue has progressed further with larger and more prominent indurations than in Stage II. Deformed lobular fat deposits that may cause considerable distortion of the limb profile are present.
(Stage IV: Involves the presence of lipo-lymphoedema)
Disease mechanisms for lipoedema
Disease mechanisms include:
- Enlargement of fat tissue either by adipocyte hypertrophy (increase in size, but not in number, of fat cells) or by adipocyte hyperplasia (increase in number of fat cells).
- Oxygen deficiency in fat tissue might contribute to the easy bruising often reported by lipoedema patients.
- Reduced skin and connective tissue elasticity.
- Compression of nerve fibers by enlarged fat deposits and/or inflammation may be the cause of pain and hypersensitivity seen in lipoedema patients.
- Development of edema (swelling). Lipoedema is often accompanied by the formation of fluid oedema (lipo-lymphoedema). This may result from increased interstitial fluid formation due to capillary fragility, mechanical obstruction of small lymphatic vessels by adipose tissue enlargement, reduced skin and connective tissue elasticity, and reduced mobility due to pain or joint problems.
Surgical procedures are indicated if – despite thorough conservative treatment – symptoms persist, or if there is progression of clinical findings and/or symptoms.
If present, morbid obesity should be therapeutically addressed prior to liposuction. Following liposuction, patients should wear compression garments for several weeks.