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Malcolm L. A retrospective comparative study of patient-reported outcome measures, pre-treatment and twelve months post-treatment using tumescent liposuction for the management of lower limb lipoedema. JPRAS Open 2024; 41:285-294. [PMID: 39161914 PMCID: PMC11332691 DOI: 10.1016/j.jpra.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/19/2024] [Indexed: 08/21/2024] Open
Abstract
Background Lipoedema is a painful adipose tissue disorder, affecting the limbs of women, that is resistant to diet and exercise. The purpose of the study was to evaluate the retrospective health-related quality-of-life (HRQoL) outcomes for patients with lower limb lipoedema (LLL) following tumescent liposuction (TL). Methods Forty-seven patients received TL over 5 years from 2015-2020 for LLL. As part of their routine treatment evaluation, each patient completed 4 validated HRQoL questionnaires at initial assessment. The questionnaires examined the patients' experiences relating to anxiety and depression, lower extremity function, appearance, and symptoms. The same questionnaires were posted to the patients after an average of 12 months post-procedure/s to establish the outcomes of the intervention. Results The study demonstrated that patients' HRQoL improved at 12 months (average) following TL. The results of all the questionnaires were statistically significant, and patients with stage 3 LLL showed the most improvement in outcomes. Conclusion The findings demonstrated that TL achieves positive HRQoL outcomes in patients with LLL; however, long-term follow-up is needed to determine if the benefits sustain. Additionally, larger prospective controlled studies are required to provide robust evidence for this procedure.
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Affiliation(s)
- Lynne Malcolm
- School of Nursing, The University of Wolverhampton, Birmingham, West Midlands, UK
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2
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Fijany AJ, Ford AL, Assi PE, Hung YC, Montorfano L, Mubang RN, Karagoz H. Comparing the safety and effectiveness of different liposuction techniques for lipedema. J Plast Reconstr Aesthet Surg 2024; 97:256-267. [PMID: 39173577 DOI: 10.1016/j.bjps.2024.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Lipedema is a relatively common, frequently misdiagnosed, chronic condition that is often treated using liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL) are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aimed to assess the efficacy and safety of liposuction in patients with lipedema. METHODS Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with post-operative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, and 2 articles used PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. RESULTS A total of 2542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). TTL, PAL, and WAL led to significant improvements in pain reduction P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). However, WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for the studies that used TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). CONCLUSION Liposuction techniques, including TTL, PAL, and WAL, resulted in significant symptom improvement in patients with lipedema with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. To the best of our knowledge, this is the first meta-analysis investigating liposuction data in lipedema treatment.
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Affiliation(s)
- Arman J Fijany
- The Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Aubree L Ford
- The Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patrick E Assi
- The Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ya-Ching Hung
- The Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Ronnie N Mubang
- The Vanderbilt University Medical Center, Nashville, TN, USA
| | - Huseyin Karagoz
- The Vanderbilt University Medical Center, Nashville, TN, USA
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Dinnendahl R, Tschimmel D, Löw V, Cornely M, Hucho T. Non-obese lipedema patients show a distinctly altered quantitative sensory testing profile with high diagnostic potential. Pain Rep 2024; 9:e1155. [PMID: 38617100 PMCID: PMC11013692 DOI: 10.1097/pr9.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction and Objectives Lipedema is a widespread severe chronic disease affecting mostly women. Characterized by painful bilateral fat accumulation in extremities sparing hands and feet, objective measurement-based diagnosis is currently missing. We tested for characteristic psychometric and/or sensory alterations including pain and for their potential for medical routine diagnosis. Methods Pain psychometry was assessed using the German Pain Questionnaire. Sensory sensitivity toward painful and nonpainful stimuli was characterized in non-obese lipedema patients and matched controls using the validated quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain. Results Lipedema patients showed no overt psychometric abnormalities. Pain was reported as somatic rather than psychosomatic aversive. All QST measurements were normal, but the z-score of pressure pain thresholds (PPT) was twofold reduced and the z-score of vibration detection thresholds (VDT) was two and a half times increased. Both thresholds were selectively altered at the affected thigh but not the unaffected hand. Receiver operating characteristic analysis of the combination of PPT and VDT of thigh vs hand into a PVTH score (PPT, VDT, thigh, hand-score) shows high sensitivity and specificity, categorizing correctly 95.8% of the participants as lipedema patients or healthy controls. Bayesian inference analysis corroborated the diagnostic potential of such a combined PVTH score. Conclusion We propose to assess PPT and VDT at the painful thigh and the pain-free hand. Combination in a PVTH score may allow a convenient lipedema diagnosis early during disease development.
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Affiliation(s)
- Rebecca Dinnendahl
- Translational Pain Research, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dominik Tschimmel
- Translational Pain Research, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Vanessa Löw
- Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Manuel Cornely
- CG Lympha GmbH, Cologne, Germany
- Ly.Search GmbH, Cologne, Germany
| | - Tim Hucho
- Translational Pain Research, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
- Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
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Keith L, Seo C, Wahi MM, Huggins S, Carmody M, Faerber G, Forner-Cordero I, Michelini S, Rapprich S, Rockson SG. Proposed Framework for Research Case Definitions of Lipedema. Lymphat Res Biol 2024; 22:93-105. [PMID: 38546398 PMCID: PMC11044873 DOI: 10.1089/lrb.2023.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background: Our aim is to propose a framework for the development of a research case definition of lipedema, based on current available literature and those observations that can be applied to future lipedema research with the intent to standardize and strengthen the scientific evidence base. Methods and Results: We conducted a narrative review of the literature, and identified consensus characteristics and disputed characteristics that could be included in a research case definition of lipedema. After considering the strength of the evidence and how each characteristic might be measured in a research study, we recommended an approach for the development of a research case definition of lipedema that would be based on consideration of five agreed-upon characteristics, and five disputed, or less substantiated, characteristics as additional evidence to enhance specificity. Conclusions: We present a case definition framework for lipedema drawn from the scientific literature that can be applied to future studies on lipedema. Utilizing this framework should help to increase the sensitivity and specificity of case definition and provide an opportunity for meta-analysis of clinical studies and facilitate future research intercomparisons.
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Affiliation(s)
- Leslyn Keith
- Lipedema Project, Inc., Boston, Massachusetts, USA
| | - Catherine Seo
- Lipedema Project, Inc., Boston, Massachusetts, USA
- Lipedema Simplified, LLC, Boston, Massachusetts, USA
| | | | - Siobhan Huggins
- Lipedema Project, Inc., Boston, Massachusetts, USA
- Lipedema Simplified, LLC, Boston, Massachusetts, USA
| | - Matthew Carmody
- Lipedema Simplified, LLC, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stanley G. Rockson
- Stanford Center for Lymphatic and Venous Disorders, Stanford University School of Medicine, Stanford, California, USA
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Amato AC, Amato JL, Benitti D. Efficacy of Liposuction in the Treatment of Lipedema: A Meta-Analysis. Cureus 2024; 16:e55260. [PMID: 38558609 PMCID: PMC10981502 DOI: 10.7759/cureus.55260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Lipedema, a chronic and painful disorder primarily affecting women without a definitive cure, has traditionally been managed with conservative therapy, notably complete decongestive therapy, across many countries. Recently, liposuction has been explored as a potential surgical treatment, prompting this study to evaluate its effectiveness as possibly the first-line therapy for lipedema. Through extensive literature searches in databases such as CrossRef, Web of Science, PubMed, and Google Scholar up to December 2023, and using the Newcastle-Ottawa Scale for quality assessment, the study selected seven studies for inclusion. Results showed significant post-operative improvements in spontaneous pain, edema, bruising, mobility, and quality of life among lipedema patients undergoing liposuction. However, over half of the patients still required conservative therapy after surgery. Despite these promising results, the study suggests caution due to lipedema's complexity, significant reliance on self-reported data, and limitations of the studies reviewed. Thus, while liposuction may offer symptomatic relief, it should be considered an adjunct, experimental therapy rather than a definitive cure, emphasizing the need for a comprehensive approach to care.
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Affiliation(s)
- Alexandre C Amato
- Department of Vascular Surgery, Amato - Instituto de Medicina Avançada, Sao Paulo, BRA
| | - Juliana L Amato
- Department of Gynecology, Amato - Instituto de Medicina Avançada, São Paulo, BRA
| | - Daniel Benitti
- Department of Vascular and Endovascular Surgery, Medical Valens Center, São Paulo, BRA
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Verde L, Camajani E, Annunziata G, Sojat A, Marina LV, Colao A, Caprio M, Muscogiuri G, Barrea L. Ketogenic Diet: A Nutritional Therapeutic Tool for Lipedema? Curr Obes Rep 2023; 12:529-543. [PMID: 37924422 DOI: 10.1007/s13679-023-00536-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to provide an overview of the current evidence on the efficacy, also considering the anti-inflammatory properties and safety of very low-calorie ketogenic diet (VLCKD) as a potential treatment for lipedema, particularly in the context of obesity. RECENT FINDINGS Lipedema is a chronic disease characterized by abnormal and painful fat buildup on the legs and/or arms. It is often misdiagnosed as obesity or lymphedema. However, although lipedema and obesity can coexist, unlike obesity, lipedema usually affects the legs and thighs without affecting the feet or hands, and the abnormal deposition of adipose tissue in lipedema is painful. The current lifestyle interventions are often unsuccessful in the management of lipedema. There is no consensus on the most effective nutritional approach for managing lipedema. Recent studies have suggested that VLCKD may be an effective treatment for lipedema, demonstrating that it is also superior to other nutritional approaches such as Mediterranean diet or intermittent fasting. Lipedema is a chronic and debilitating disease characterized by abnormal and painful accumulation of adipose tissue in the legs. VLCKD has been shown to be an effective treatment for lipedema, especially in the context of obesity, due to its anti-inflammatory properties. However, further research is needed to determine the long-term safety and efficacy of VLCKD as a treatment for lipedema.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Giuseppe Annunziata
- Department of Experimental Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Antoanstefan Sojat
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ljiljana V Marina
- Department for Obesity, Metabolic and Reproductive Disorders, Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia ed Andrologia, Unità di Endocrinologia, Università Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia ed Andrologia, Unità di Endocrinologia, Università Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy.
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143, Naples, Italy
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Funke S, Kuhlmann C, Taha S, Fuchs B, Wiggenhauser PS, Giunta RE. [Searching for Evidence: A Systematic Review of the Pathology of Lipoedema]. HANDCHIR MIKROCHIR P 2023; 55:411-426. [PMID: 37984363 DOI: 10.1055/a-2183-7414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Lipoedema is a symmetrically localised, painful hypertrophy of subcutaneous adipose tissue in the extremities with marked disproportion to the trunk, and almost exclusively affects females. Despite being first described over 80 years ago, the aetiology and pathogenesis of the disease are largely unknown and are currently the subject of intensive research efforts. METHODS To summarise the current evidence-based literature on the cellular pathologies and aetiology of lipoedema, a PRISMA-based systematic review was conducted within the National Library of Medicine and Cochrane databases. RESULTS A total of 53 studies were identified and included in this review. The results were classified and summarised into categories. CONCLUSION Although there has been a significant increase in research activity and recent publication of extensive studies with a histological and molecular genetic focus, the fundamental aetiology and pathology of lipoedema remains largely unclear. The current data shows discrepancies across studies, particularly with regard to the "oedematous" component of lipoedema. The frequently present comorbidities "lymphoedema" and "obesity", primarily in advanced stages of lipoedema, complicate the diagnostic differentiation and clear definition of study cohorts in scientific research.
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Affiliation(s)
- Sarah Funke
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU-Klinikum, Ludwig-Maximilians-Universität, München, Deutschland
| | - Constanze Kuhlmann
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU-Klinikum, Ludwig-Maximilians-Universität, München, Deutschland
| | - Sara Taha
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU-Klinikum, Ludwig-Maximilians-Universität, München, Deutschland
| | - Benedikt Fuchs
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU-Klinikum, Ludwig-Maximilians-Universität, München, Deutschland
| | - Paul Severin Wiggenhauser
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU-Klinikum, Ludwig-Maximilians-Universität, München, Deutschland
| | - Riccardo E Giunta
- Abteilung für Handchirurgie, Plastische und Ästhetische Chirurgie, LMU-Klinikum, Ludwig-Maximilians-Universität, München, Deutschland
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van la Parra RFD, Deconinck C, Pirson G, Servaes M, Fosseprez P. Lipedema: What we don't know. J Plast Reconstr Aesthet Surg 2023; 84:302-312. [PMID: 37390539 DOI: 10.1016/j.bjps.2023.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Lipedema is a loose connective tissue disease characterized by a disproportionate accumulation of adipose tissue in the limbs of women. Despite its incidence of 10-20%, lipedema is often underdiagnosed and misdiagnosed. OBJECTIVES This review aims to outline current, available evidence regarding this enigmatic syndrome and gives a synopsis of the subjects that are still unknown. MATERIALS AND METHODS PubMed and Embase searches were conducted to identify relevant articles on lipedema pathophysiology, clinical presentation, diagnosis, and treatment. RESULTS Lipedema can be considered a disease of the adipocytes or a circulatory disorder of the lymphatics. The relationship between lymphatics and adipose tissue remains controversial. The clinical distinction between lipedema, lymphedema, phlebolymphedema, and lipolymphedema can be difficult. Diagnoses often coexist, further complicating the diagnosis of lipedema, which is currently made on clinical grounds alone. The value of diagnostic imaging studies is unclear. Liposuction appears to be an effective treatment and significantly improves symptoms. CONCLUSION Diagnosing lipedema remains a challenge due to its heterogeneous presentation, co-existing diseases, and lack of objective diagnostic imaging. Further directions for research include the effect of excess skin resection surgery on lymphatic drainage.
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Affiliation(s)
- R F D van la Parra
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium.
| | - C Deconinck
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - G Pirson
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - M Servaes
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - Ph Fosseprez
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
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Hansdorfer-Korzon R, Czerwińska M, Teodorczyk J, Szamotulska J. Assessment of lipoedema awareness among polish women- online survey study. BMC Womens Health 2023; 23:457. [PMID: 37644422 PMCID: PMC10464337 DOI: 10.1186/s12905-023-02614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Lipoedema is an adipose tissue disorder that is still not fully understood. The primary purpose of this study is to explore the state of knowledge and understanding of lipoedema among Polish women. The secondary aim is to investigate the possible association between knowledge and factors such as BMI, self-reported symptoms, and age. METHODS One hundred seventy polish women took part in an online survey study that was posted to social media groups and forums in January 2022. The survey consisted of 12 questions and aimed at assessing the basic knowledge about lipoedema. RESULTS The least proportion of participants (4%) could correctly indicate the methods of lipoedema treatment. The accurate definition of lipoedema was indicated only by 7% of women, 12% identified characteristic features of lipoedema, and 37% correctly evaluated lipoedema curability. The greatest proportion of respondents knew the differences between obesity and lipoedema (50%). CONCLUSIONS Awareness of lipoedema among women is deficient. A significant proportion of the respondents report the occurrence of lipoedema symptoms. In order to improve the situation of lipoedema patients, it is crucial to increase the knowledge about this condition both among medical professionals and the general public.
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Affiliation(s)
- Rita Hansdorfer-Korzon
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, Gdańsk, 80-211 Poland
| | - Monika Czerwińska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, Gdańsk, 80-211 Poland
| | - Jacek Teodorczyk
- Department of Nuclear Medicine and Radiology Informatics, Medical University of Gdańsk, 17 Mariana Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Jolanta Szamotulska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, Gdańsk, 80-211 Poland
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Rastel D, Urbinelli R. Frequency of lipoedema in patients consulting a vein clinic for mild to moderate superficial venous disorder with symptoms: A retrospective analysis. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:55-61. [PMID: 37422328 DOI: 10.1016/j.jdmv.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/05/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Lower limb lipoedema is a chronic condition of the adipose connective tissue of the skin that affects women. Its frequency is not well known, hence the main objective of this study. METHOD Retrospective analysis of the records of phlebology consultations in private practice in a single center from April 2020 to April 2021. Inclusion criteria were: women aged 18 to 80 years, presenting with symptoms attributable to veins and the presence of at least one dilated reticular vein. RESULTS The files of 464 patients were analyzed. 7.7% had lipoedema, 3.7% lymphedema, 3% stage 3 obesity. The 36 patients with lipoedema were 54.7±16 years old (mean, Standard Deviation), with a Body Mass Index of 31.3±5.5. Leg pain was the major symptom (32/36) and no patient had a positive pitting test. CONCLUSION Lipoedema is a frequent condition in phlebology consultations.
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Affiliation(s)
- Didier Rastel
- Vascular Physician, 30, place Louis Jouvet, 38100 Grenoble, France.
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11
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Czerwińska M, Teodorczyk J, Spychała D, Hansdorfer-Korzon R. The Usefulness of the Application of Compression Therapy among Lipedema Patients-Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:914. [PMID: 36673666 PMCID: PMC9859460 DOI: 10.3390/ijerph20020914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Although lipedema has gained more interest among researchers, specific treatment methods are still unknown. This study aims to identify the effects of compression therapy combined with exercises compared to exercising only. Moreover, the aim is to assess the methodology and outcome measurements before conducting a larger study. (2) Methods: Six women with lipedema were enrolled in the study; three were undergoing exercise program and compression therapy using compression leggings, and the remaining three were undergoing exercises only. During the first 4 weeks, intervention was under the supervision of a physiotherapist, and in the remaining weeks, participants were exercising independently. Measurements of circumference, weight, thickness of the skin and adipose tissue, symptom severity, and quality of life were taken at baseline, after 4 weeks and after 6 weeks; (3) Results: There was a significant decrease in the subjectively reported tendency for bruising and pain at palpation among patients that received compression therapy. Additionally, there was a tendency to reduce or maintain the circumference of the legs in patients using compression, while it tended to increase in patients without compression. (4) Conclusions: Preliminary results indicate that compression therapy, combined with exercises, could improve the quality of life and decrease the severity of lipedema symptoms. Further studies on a large clinical group are advisable.
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Affiliation(s)
- Monika Czerwińska
- Department of Physiotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Jacek Teodorczyk
- Department of Nuclear Medicine and Radiology Informatics, Medical University of Gdańsk, 17 Mariana Smoluchowskiego Street, 80-214 Gdańsk, Poland
| | - Dawid Spychała
- Department of Physiotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland
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Al-Wardat M, Clarke C, Alwardat N, Kassab M, Salimei C, Gualtieri P, Marchetti M, Best T, Di Renzo L. The Difficulties in Emotional Regulation among a Cohort of Females with Lipedema. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13679. [PMID: 36294260 PMCID: PMC9602978 DOI: 10.3390/ijerph192013679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Lipedema is a chronic and progressive adipose tissue disorder that causes significant morbidity and negatively influences mental health and quality of life, and increases the risk of depression, anxiety, and eating disorders. One construct of relevance to better understanding psychological disorders is emotion regulation (ER). Therefore, the aim of this study is to investigate the difficulties in ER among lipedema patients compared to healthy people without lipedema. METHODS This cross-sectional study assessed differences in ER and anxiety between two groups: 26 female patients with lipedema and 26 sex- and age-matched healthy controls. The Difficulties in Emotion Regulation Scale (DERS) assessed emotional regulation across six dimensions: Impulse control, goal-directed behavior, awareness, clarity, non-acceptance, and strategies. Anxiety was assessed by the Hamilton Anxiety Scale (HAM-A). ANOVA assessed differences in measures between lipedema and healthy control groups. RESULTS Lipedema patients presented with significantly more difficulties in ER and a higher level of anxiety than those without lipedema. Specifically, the lipedema group showed higher and significant differences in total DERS and anxiety scores and all DERS subscales scores compared to those without lipedema. CONCLUSIONS Lipedema patients showed significant difficulties with ER, and were associated with anxiety symptoms, indicating that ER difficulties may play a role in developing emotional disorders, such as anxiety, for patients with lipedema. The health care provider should pay more attention to ER difficulties and psychological status among lipedema patients.
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Affiliation(s)
- Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Chantelle Clarke
- NeuroHealth Lab, Appleton Institute, School of Health, Medical and Applied Sciences, CQUniversity Australia, Brisbane 4000, Australia
| | - Nuha Alwardat
- Faculty of Applied Medical Sciences, Jerash University, Jerash P.O. Box 311, Jordan
| | - Manal Kassab
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Chiara Salimei
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Marco Marchetti
- Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Talitha Best
- NeuroHealth Lab, Appleton Institute, School of Health, Medical and Applied Sciences, CQUniversity Australia, Brisbane 4000, Australia
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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13
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A Scoping Review of Available Tools in Measurement of the Effectiveness of Conservative Treatment in Lipoedema. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127124. [PMID: 35742373 PMCID: PMC9222339 DOI: 10.3390/ijerph19127124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
(1) Background: Due to insufficient knowledge of lipoedema, the treatment of this disease is undoubtedly challenging. However, more and more researchers attempt to incorporate the most effective lipoedema treatment methods. When assessing a new therapeutic method, choosing correct, objective tools to measure the therapeutic outcome is very important. This article aims to present possible instruments that may be used in the evaluation of therapeutic effects in patients with lipoedema. (2) Methods: The data on therapeutic outcome measurements in lipoedema were selected in February 2022, using the Medical University of Gdansk Main Library multi-search engine. (3) Results: In total, 10 papers on this topic have been identified according to inclusion criteria. The tools evaluating the therapeutic outcomes used in the selected studies were: volume and circumference measurement, body mass index, waist-to-hip ratio, ultrasonography and various scales measuring the quality of life, the level of experiencing pain, the severity of symptoms, functional lower extremity scales, and a 6 min walk test. (4) Conclusion: The tools currently used in evaluating the effectiveness of conservative treatment in women with lipoedema are: volume and circumference measurement, waist-to-hip ratio, body fat percentage, ultrasonography, VAS scale, quality of life scales (SF-36, RAND-36), symptom severity questionnaire (QuASiL), Lower Extremity Functional Scale and 6 min walk. Choosing a proper tool to measure the treatment outcome is essential to objectively rate the effectiveness of therapeutic method.
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14
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Strohmeier K, Hofmann M, Jacak J, Narzt MS, Wahlmueller M, Mairhofer M, Schaedl B, Holnthoner W, Barsch M, Sandhofer M, Wolbank S, Priglinger E. Multi-Level Analysis of Adipose Tissue Reveals the Relevance of Perivascular Subpopulations and an Increased Endothelial Permeability in Early-Stage Lipedema. Biomedicines 2022; 10:biomedicines10051163. [PMID: 35625899 PMCID: PMC9138324 DOI: 10.3390/biomedicines10051163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Lipedema is a chronic, progressive disease of adipose tissue with unknown etiology. Based on the relevance of the stromal vascular fraction (SVF) cell population in lipedema, we performed a thorough characterization of subcutaneous adipose tissue, SVF isolated thereof and the sorted populations of endothelial cells (EC), pericytes and cultured adipose-derived stromal/stem cells (ASC) of early-stage lipedema patients. We employed histological and gene expression analysis and investigated the endothelial barrier by immunofluorescence and analysis of endothelial permeability in vitro. Although there were no significant differences in histological stainings, we found altered gene expression of factors relevant for local estrogen metabolism (aromatase), preadipocyte commitment (ZNF423) and immune cell infiltration (CD11c) in lipedema on the tissue level, as well as in distinct cellular subpopulations. Machine learning analysis of immunofluorescence images of CD31 and ZO-1 revealed a morphological difference in the cellular junctions of EC cultures derived from healthy and lipedema individuals. Furthermore, the secretome of lipedema-derived SVF cells was sufficient to significantly increase leakiness of healthy human primary EC, which was also reflected by decreased mRNA expression of VE-cadherin. Here, we showed for the first time that the secretome of SVF cells creates an environment that triggers endothelial barrier dysfunction in early-stage lipedema. Moreover, since alterations in gene expression were detected on the cellular and/or tissue level, the choice of sample material is of high importance in elucidating this complex disease.
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Affiliation(s)
- Karin Strohmeier
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
| | - Martina Hofmann
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
- School of Medical Engineering and Applied Social Science, University of Applied Sciences Upper Austria, 4020 Linz, Austria
| | - Jaroslaw Jacak
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
- School of Medical Engineering and Applied Social Science, University of Applied Sciences Upper Austria, 4020 Linz, Austria
| | - Marie-Sophie Narzt
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
| | - Marlene Wahlmueller
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
| | - Mario Mairhofer
- Department of Hematology and Internal Oncology, Johannes Kepler University, 4020 Linz, Austria;
| | - Barbara Schaedl
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
- University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang Holnthoner
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
| | - Martin Barsch
- Austrian Center for Lipedema, Skin Aesthetic Vein Laser Practice, 4020 Linz, Austria; (M.B.); (M.S.)
| | - Matthias Sandhofer
- Austrian Center for Lipedema, Skin Aesthetic Vein Laser Practice, 4020 Linz, Austria; (M.B.); (M.S.)
| | - Susanne Wolbank
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
| | - Eleni Priglinger
- Ludwig Boltzmann Institute for Traumatology in Cooperation with the AUVA, 1200 Vienna, Austria; (K.S.); (M.-S.N.); (M.W.); (B.S.); (W.H.); (S.W.)
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria; (M.H.); (J.J.)
- Correspondence:
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15
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Volkan-Yazici M, Esmer M. Reducing Circumference and Volume in Upper Extremity Lipedema: The Role of Complex Decongestive Physiotherapy. Lymphat Res Biol 2022; 20:71-75. [PMID: 33798399 DOI: 10.1089/lrb.2020.0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on upper extremity circumference and volume in patients with lipedema. Methods and Results: All participants included in the study were included in a treatment protocol consisting of CDP and IPC. The Perometer 400 NT was used in the measurement of upper extremity volume and circumference before and after treatment. The measurements were performed in four reference points. According to the Perometer results before and after CDP, statistically significant reduction was found in the circumference of 3 of the 4 points of measurements performed in each of the left and right upper extremities. When the volume assessments were compared, it was seen that statistically significant reduction was found in the volume of both limbs. Conclusion: A treatment program consisting of CDP and IPC can be effective in reducing the circumference and volume of the arm in patients with upper extremity lipedema. So, CDP applications can help prevent the development of complications such as lipolymphedema, hypertension, and heart failure. Clinical Trial Registration number: NCT04643392 https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AF9B&selectaction=Edit&uid=U00055NT&ts=2&cx=-3oevdw.
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Affiliation(s)
- Melek Volkan-Yazici
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey
| | - Murat Esmer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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16
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Sørlie V, De Soysa AK, Hyldmo AA, Retterstøl K, Martins C, Nymo S. Effect of a ketogenic diet on pain and quality of life in patients with lipedema: The LIPODIET pilot study. Obes Sci Pract 2021; 8:483-493. [PMID: 35949278 PMCID: PMC9358738 DOI: 10.1002/osp4.580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vilde Sørlie
- Department of Nutrition Institute of Basic Medical Sciences Faculty of Medicine University of Oslo Oslo Norway
| | - Ann Kristin De Soysa
- Department of clinical nutrition and speech pathology Clinic of Clinical Services St. Olav Hospital—Trondheim University Hospital Norway
| | - Åsne Ask Hyldmo
- Centre of Obesity research and innovation Clinic of Surgery St. Olav Hospital —Trondheim University Hospital Norway
| | - Kjetil Retterstøl
- Department of Nutrition Institute of Basic Medical Sciences Faculty of Medicine University of Oslo Oslo Norway
| | - Catia Martins
- Centre of Obesity research and innovation Clinic of Surgery St. Olav Hospital —Trondheim University Hospital Norway
- Centre for Obesity Research Department of Clinical and Molecular Medicine Faculty of Medicine Norwegian of Science and Technology Trondheim Norway
| | - Siren Nymo
- Department of clinical nutrition and speech pathology Clinic of Clinical Services St. Olav Hospital—Trondheim University Hospital Norway
- Centre for Obesity Research Department of Clinical and Molecular Medicine Faculty of Medicine Norwegian of Science and Technology Trondheim Norway
- Namsos Hospital Clinic of Surgery Nord‐Trondelag Hospital Trust Norway
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17
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Amato ACM, Benitti DA. Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934406. [PMID: 34871293 PMCID: PMC8667633 DOI: 10.12659/ajcr.934406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/30/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lipedema is a chronic progressive disease characterized by the abnormal accumulation of fat in the subcutaneous region. Both medical and surgical treatments have been described in international guidelines; however, the current literature is biased toward promoting liposuction as the primary treatment of lipedema, and this can lead to the misapprehension that liposuction is the only form of definitive treatment. CASE REPORT In the present study, we report 5 cases at various stages of the evolution of lipedema, all with different therapeutic objectives. Case 1 reported having persistent bruising and pain, case 2 reported pain and fat deposition, case 3 reported night cramps and discomfort, case 4 reported leg thickening, and case 5 reported redness in the legs. All of were diagnosed with lipedema in different evolution stages. Our purpose was to demonstrate the possibility of non-surgical therapy, as well as to improve signs and symptoms of lipedema, using the QuASiL questionnaire and measuring changes in volumes and proportions. Good aesthetic outcomes improve both social and psychological status. CONCLUSIONS Currently, there are many described therapies available for lipedema. Liposuction surgery for lipedema should be considered one possible tool. Treatment objectives can be different for each patient. It is imperative to understand each patient's needs in order to offer the best therapy attainable that meets patient requirements and induces a better quality of life. Non-surgical treatment of lipedema is feasible in selected cases, and it can meet the criteria for achieving selected clinical objectives.
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Affiliation(s)
- Alexandre Campos Moraes Amato
- Department of Vascular Surgery, University of Santo Amaro (UNISA), São Paulo, SP, Brazil
- Department of Vascular Surgery, Institute of Advanced Medicine (AMATO), São Paulo, SP, Brazil
| | - Daniel Augusto Benitti
- Department of Vascular and Endovascular Surgery, Medical Valens Center, Campinas, SP, Brazil
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18
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Donahue PMC, Crescenzi R, Petersen KJ, Garza M, Patel N, Lee C, Chen SC, Donahue MJ. Physical Therapy in Women with Early Stage Lipedema: Potential Impact of Multimodal Manual Therapy, Compression, Exercise, and Education Interventions. Lymphat Res Biol 2021; 20:382-390. [PMID: 34748408 PMCID: PMC9422785 DOI: 10.1089/lrb.2021.0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Lipedema is a distinct adipose disorder from obesity necessitating awareness as well as different management approaches to address pain and optimize quality of life (QoL). The purpose of this proof-of-principle study is to evaluate the therapeutic potential of physical therapy interventions in women with lipedema. Methods and Results: Participants with Stage 1-2 lipedema and early Stage 0-1 lymphedema (n = 5, age = 38.4 ± 13.4 years, body mass index = 27.2 ± 4.3 kg/m2) underwent nine visits of physical therapy in 6 weeks for management of symptoms impacting functional mobility and QoL. Pre- and post-therapy, participants were scanned with 3 Tesla sodium and water magnetic resonance imaging (MRI), underwent biophysical measurements, and completed questionnaires measuring function and QoL (patient-specific functional scale, PSFS, and RAND-36). Pain was measured at each visit using the 0-10 visual analog scale (VAS). Treatment effect was calculated for all study variables. The primary symptomatology measures of pain and function revealed clinically significant post-treatment improvements and large treatment effects (Cohen's d for pain VAS = -2.5 and PSFS = 4.4). The primary sodium MRI measures, leg skin sodium, and subcutaneous adipose tissue (SAT) sodium, reduced following treatment and revealed large treatment effects (Cohen's d for skin sodium = -1.2 and SAT sodium = -0.9). Conclusions: This proof-of-principle study provides support that persons with lipedema can benefit from physical therapy to manage characteristic symptoms of leg pain and improve QoL. Objective MRI measurement of reduced tissue sodium in the skin and SAT regions indicates reduced inflammation in the treated limbs. Further research is warranted to optimize the conservative therapy approach in lipedema, a condition for which curative and disease-modifying treatments are unavailable.
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Affiliation(s)
- Paula M C Donahue
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Kalen J Petersen
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maria Garza
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Niral Patel
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chelsea Lee
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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19
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Podda M, Kovacs M, Hellmich M, Roth R, Zarrouk M, Kraus D, Prinz-Langenohl R, Cornely OA. A randomised controlled multicentre investigator-blinded clinical trial comparing efficacy and safety of surgery versus complex physical decongestive therapy for lipedema (LIPLEG). Trials 2021; 22:758. [PMID: 34717741 PMCID: PMC8557553 DOI: 10.1186/s13063-021-05727-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipedema is a chronic disorder of the adipose tissue that affects mainly women, characterised by symmetrical, excessive fatty tissue on the legs and pain. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial well-being, mobility and physical activity. Patients may benefit from surgical removal of abnormally propagated adipose tissue by liposuction. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT. METHODS/DESIGN LIPLEG is a randomised controlled multicentre investigator-blinded trial. Women with lipedema (n=405) without previous liposuction will be allocated 2:1 to liposuction or CDT. The primary outcome of the trial is leg pain reduction by ≥2 points on a visual analogue scale ranging 0-10 at 12 months on CDT or post-completion of liposuction. Secondary outcomes include changes in leg pain severity, health-related quality of life, depression tendency, haematoma tendency, prevalence of oedema, modification physical therapy scope, body fat percentage, leg circumference and movement restriction. The primary analysis bases on intention-to-treat. Success proportions are compared using the Mantel-Haenszel test stratified by lipedema stage at a 5% two-sided significance level. If this test is statistically significant, the equality of the response proportions in the separate strata is evaluated by Fisher's exact test in a hierarchical test strategy. DISCUSSION LIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues. The findings of this trial have the potential to change the standard of care in lipedema. TRIAL REGISTRATION ClinicalTrials.gov NCT04272827. Registered on February 14, 2020. TRIAL STATUS Protocol version is 02_0, December 17, 2019.
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Affiliation(s)
- Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Grafenstr. 9, 64283 Darmstadt, Germany
| | - Maximilian Kovacs
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Grafenstr. 9, 64283 Darmstadt, Germany
| | - Martin Hellmich
- University of Cologne, Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 10, 50924 Cologne, Germany
| | - Rebecca Roth
- University of Cologne, Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 10, 50924 Cologne, Germany
| | - Marouan Zarrouk
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Herderstr. 52, 50931 Cologne, Germany
- Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
| | - Daria Kraus
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
| | - Reinhild Prinz-Langenohl
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
| | - Oliver A. Cornely
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Herderstr. 52, 50931 Cologne, Germany
- Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
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20
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Hesse U, Hesse A, Hesse L, Schultz E, Kaiser M. Lipödem heute: Zwischen konservativer Therapie, Liposuktion und Adipositaschirurgie. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1525-5956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie zunehmende Prävalenz des Lipödems geht einher mit einer demografischen Zunahme der Adipositas per magna.Konservative und operative Maßnahmen ermöglichen eine ausgeprägte Befund- und Beschwerdebesserung.Die exakte Diagnose und Differenzierung zwischen therapiebedürftiger Adipositas und therapiebedürftigem Lipödem entscheiden über Erfolg und Misserfolg der eingeleiteten Therapie.Nach konservativem Therapieversuch kann die operative Versorgung bei Ausbleiben einer entsprechenden Besserung durch Liposuktion oder adipositaschirurgische Intervention bei einem erheblichen Teil der Betroffenen die konservative Therapie reduzieren bzw. teilweise sogar ganz überflüssig machen.
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Affiliation(s)
- U. Hesse
- Adipositas und Metabolische Chirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
- Praxis für Chirurgie und Venentherapie, Sindelfingen
| | - A. Hesse
- Praxis für Allgemeinmedizin, Stuttgart
| | - L. Hesse
- Cand. Med. Universität Pécs, Ungarn
| | - E. Schultz
- Klinik für Dermatologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - M. Kaiser
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
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21
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Czerwińska M, Ostrowska P, Hansdorfer-Korzon R. Lipoedema as a Social Problem. A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10223. [PMID: 34639524 PMCID: PMC8508106 DOI: 10.3390/ijerph181910223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/18/2021] [Accepted: 09/25/2021] [Indexed: 01/03/2023]
Abstract
(1) Background: Lipoedema is a disease characterized by excessive bilateral and symmetrical accumulation of subcutaneous tissue in the lower extremities. It is a poorly understood condition, and low awareness of its existence often leads to incorrect diagnosis Initially, lipoedema was considered to be completely independent of lifestyle Currently, however, more and more cases of the coexistence of lipoedema and obesity are described in the literature as additionally affecting the severity of the disease The aim of the review is to present lipoedema as a social problem. (2) Methods: Materials on lipoedema in the social context were selected from 2018-2021. The PRISMA-Scr checklist was used in the review. (3) Results: Research has shown that more than 3/4 of patients with lipoedema are also overweight or obese. Patients with lipoedema have many comorbidities, and their presence negatively affects the quality of life. The quality of life in patients with lipoedema is lower than in healthy patients. (4) Conclusions: The number of studies available on lipoedema is low. Obesity is common in patients with lipoedema. Mental disorders increase the level of experienced pain. Lipoedema significantly reduces quality of life. A healthy lifestyle in patients with lipoedema could be helpful for prevention of complications and disability.
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Affiliation(s)
- Monika Czerwińska
- Department of Physiotherapy, Medical University of Gdańsk, 80-211 Gdańsk, Poland; (P.O.); (R.H.-K.)
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22
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Abstract
Lipedema is a chronic, progressive disease that almost exclusively affects women and often misdiagnosed as obesity or primary lymphedema. Research concerning lipedema is sparse, and there is a lack of studies focusing on women's experiences of living with the illness. We interviewed fourteen women with lipedema with the aim of describing their experiences of living with lipedema. Our results show that women felt controlled by their body, and were fat-shamed and viewed by others as a person who lacked character. They received unsupportive advice on how to manage from healthcare, and blamed themselves while striving to take responsibility.
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Affiliation(s)
- Catharina Melander
- Department of Health, Education and Technology, Luleå University of Technology, Sweden
| | - Päivi Juuso
- Department of Health, Education and Technology, Luleå University of Technology, Sweden
| | - Malin Olsson
- Department of Health, Education and Technology, Luleå University of Technology, Sweden.,Department of Caring Sience, Ersta Sköndal Bräcke University College, Sweden
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23
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Keith L, Seo CA, Rowsemitt C, Pfeffer M, Wahi M, Staggs M, Dudek J, Gower B, Carmody M. Ketogenic diet as a potential intervention for lipedema. Med Hypotheses 2020; 146:110435. [PMID: 33303304 DOI: 10.1016/j.mehy.2020.110435] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
Lipedema (LI) is a common yet misdiagnosed condition, often misconstrued with obesity. LI affects women almost exclusively, and its painful and life-changing symptoms have long been thought to be resistant to the lifestyle interventions such as diet and exercise. In this paper, we discuss possible mechanisms by which patients adopting a ketogenic diet (KD) can alleviate many of the unwanted clinical features of LI. This paper is also an effort to provide evidence for the hypothesis of the potency of this dietary intervention for addressing the symptoms of LI. Specifically, we examine the scientific evidence of effectiveness of adopting a KD by patients to alleviate clinical features associated with LI, including excessive and disproportionate lower body adipose tissue (AT) deposition, pain, and reduction in quality of life (QoL). We also explore several clinical features of LI currently under debate, including the potential existence and nature of edema, metabolic and hormonal dysfunction, inflammation, and fibrosis. The effectiveness of a KD on addressing clinical features of LI has been demonstrated in human studies, and shows promise as an intervention for LI. We hope this paper leads to an improved understanding of optimal nutritional management for patients with LI and stimulates future research in this area of study.
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Affiliation(s)
- L Keith
- The Lipedema Project, Boston, MA, USA; Lipedema Simplified, Boston, MA, USA.
| | - C A Seo
- The Lipedema Project, Boston, MA, USA; Lipedema Simplified, Boston, MA, USA
| | - C Rowsemitt
- Lipedema Simplified, Boston, MA, USA; Comprehensive Weight Management, Templeton, CA and Providence, RI, USA; The Lipedema Project: Medical Advisory Board, Boston, MA, USA
| | - M Pfeffer
- Lipedema Simplified, Boston, MA, USA; The Lipedema Project: Medical Advisory Board, Boston, MA, USA; I Choose Health, Metung, Australia
| | - M Wahi
- DethWench Professional Services, Boston, MA, USA
| | - M Staggs
- Lipedema Simplified, Boston, MA, USA
| | - J Dudek
- The Lipedema Project: Medical Advisory Board, Boston, MA, USA; SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - B Gower
- University of Alabama at Birmingham, Department of Nutrition Sciences, Birmingham, AL, USA
| | - M Carmody
- Harvard Medical School, Boston, MA, USA
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24
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Affiliation(s)
- Tobias Bertsch
- Földi Clinic, Hinterzarten-European Center of Lymphology, Germany
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25
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Volkan-Yazıcı M, Yazici G, Esmer M. The Effects of Complex Decongestive Physiotherapy Applications on Lower Extremity Circumference and Volume in Patients with Lipedema. Lymphat Res Biol 2020; 19:111-114. [PMID: 33124947 DOI: 10.1089/lrb.2020.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study is to investigate the effect of complex decongestive physiotherapy (CDP) plus intermittent pneumatic compression (IPC) applications on lower extremity limb circumference and volume in patients with lipedema. Methods and Results: In measurement of limb volume and circumference measurement, the Perometer 400 NT was used before and after treatment. The perometer measurements in this study were performed in the certain five reference points (cB, cC, cD, cE, and CF). All participants included in the study were included in a treatment protocol consisting of CDP and IPC. It was seen that statistically significant reduction was found in the circumference of 3 of the 5 points of measurements performed in the left limb, whereas statistically significant reduction was found in the circumference of 4 of the 5 points of measurements performed in the right limb. When the assessments of limb volume performed with the perometer were compared before and after CDP, it was seen that statistically significant reduction was found in the volume of both limbs. Conclusion: This reduction indicates that CDP is effective in the treatment of lower extremity lipedema. Clinicaltrials.gov with an ID of NCT04492046.
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Affiliation(s)
- Melek Volkan-Yazıcı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey
| | - Gokhan Yazici
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Murat Esmer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:396-403. [PMID: 32762835 DOI: 10.3238/arztebl.2020.0396] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/04/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lipedema is often unrecognized or misdiagnosed; despite an estimated prevalence of 10% in the overall female population, its cause is still unknown. There is increasing awareness of this condition, but its differential diagnosis can still be challenging. In this article, we summarize current hypotheses on its pathogenesis and the recommendations of current guidelines for its diagnosis and treatment. METHODS This review is based on publications about lipedema that were retrieved by a selective search in the MEDLINE, Web of Science, and Cochrane Library databases. RESULTS The pathophysiology of lipedema remains unclear. The putative causes that have been proposed include altered adipogenesis, microangiopathy, and disturbed lymphatic microcirculation. No specific biomarker has yet been found, and the diagnosis is currently made on clinical grounds alone. Ancillary tests are used only to rule out competing diagnoses. The state of the evidence on treatment is poor. Treatment generally consists of complex decongestive therapy. In observational studies, liposuction for the permanent reduction of adipose tissue has been found to relieve symptoms to a significant extent, with only rare complications. The statutory healthinsurance carriers in Germany do not yet regularly cover the cost of the procedure; studies of high methodological quality will be needed before this is the case. CONCLUSION The diagnosis of lipedema remains a challenge because of the hetero - geneous presentation of the condition and the current lack of objective measuring instruments to characterize it. This review provides a guide to its diagnosis and treatment in an interdisciplinary setting. Research in this area should focus on the elucidation of the pathophysiology of lipedema and the development of a specific biomarker for it.
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Affiliation(s)
- Philipp Kruppa
- Department of Plastic, Aesthetic, Hand and Reconstructive Micro Surgery, Klinikum Ernst von Bergmann, Potsdam; Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg; Department of Angiology, Klinikum Ernst von Bergmann, Potsdam
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27
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The effect of lipedema on health-related quality of life and psychological status: a narrative review of the literature. Eat Weight Disord 2020; 25:851-856. [PMID: 31062201 DOI: 10.1007/s40519-019-00703-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of this narrative review of the literature was to evaluate and summarize the current literature regarding the effect of lipedema on health-related quality of life (HRQOL) and psychological status. METHODS The authors collected articles through a search into Medline, Embase, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cochrane Review. Search terms used included "Lipoedema," "Lipedema," "psychological status," "Quality of life," "Health related quality of life," and "HRQOL." RESULTS A total of four observational studies were evaluated. The included studies were moderate-quality according to the Newcastle-Ottawa Scale. Three of the included studies demonstrated deterioration of HRQOL and psychological status in patients with lipedema. These studies also identify that pain and tenderness are a more common and dominant characteristic. CONCLUSION Future studies should establish a specific approach to treat and manage lipedema symptoms. Based on this narrative review of the literature findings, we recommended for the health care provider to pay more attention to HRQOL and psychological status. Moreover, validated and adapted measures of HRQOL and psychological status for patients with lipedema are required. LEVEL OF EVIDENCE Level V, narrative review.
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28
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Increased levels of VEGF-C and macrophage infiltration in lipedema patients without changes in lymphatic vascular morphology. Sci Rep 2020; 10:10947. [PMID: 32616854 PMCID: PMC7331572 DOI: 10.1038/s41598-020-67987-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022] Open
Abstract
Lipedema is a chronic adipose tissue disorder characterized by the disproportional subcutaneous deposition of fat and is commonly misdiagnosed as lymphedema or obesity. The molecular determinants of the lipedema remain largely unknown and only speculations exist regarding the lymphatic system involvement. The aim of the present study is to characterize the lymphatic vascular involvement in established lipedema. The histological and molecular characterization was conducted on anatomically-matched skin and fat biopsies as well as serum samples from eleven lipedema and ten BMI-matched healthy patients. Increased systemic levels of vascular endothelial growth factor (VEGF)-C (P = 0.02) were identified in the serum of lipedema patients. Surprisingly, despite the increased VEGF-C levels no morphological changes of the lymphatic vessels were observed. Importantly, expression analysis of lymphatic and blood vessel-related genes revealed a marked downregulation of Tie2 (P < 0.0001) and FLT4 (VEGFR-3) (P = 0.02) consistent with an increased macrophage infiltration (P = 0.009), without changes in the expression of other lymphatic markers. Interestingly, a distinct local cytokine milieu, with decreased VEGF-A (P = 0.04) and VEGF-D (P = 0.02) expression was identified. No apparent lymphatic anomaly underlies lipedema, providing evidence for the different disease nature in comparison to lymphedema. The changes in the lymphatic-related cytokine milieu might be related to a modified vascular permeability developed secondarily to lipedema progression.
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29
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Petersen KJ, Garza M, Donahue PM, Harkins KD, Marton A, Titze J, Donahue MJ, Crescenzi R. Neuroimaging of Cerebral Blood Flow and Sodium in Women with Lipedema. Obesity (Silver Spring) 2020; 28:1292-1300. [PMID: 32568462 PMCID: PMC7360333 DOI: 10.1002/oby.22837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/16/2020] [Accepted: 04/09/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Lipedema is characterized by pain, fatigue, and excessive adipose tissue and sodium accumulation of the lower extremities. This case-control study aims to determine whether sodium or vascular dysfunction is present in the central nervous system. METHODS Brain magnetic resonance imaging was performed at 3 T in patients with lipedema (n = 15) and control (n = 18) participants matched for sex, age, race, and BMI. Standard anatomical imaging and intracranial angiography were applied to evaluate brain volume and vasculopathy, respectively; arterial spin labeling and sodium magnetic resonance imaging were applied to quantify cerebral blood flow (CBF) (milliliters per 100 grams of tissue/minute) and brain tissue sodium content (millimoles per liter), respectively. A Mann-Whitney U test (significance criteria P < 0.05) was applied to evaluate group differences. RESULTS No differences in tissue volume, white matter hyperintensities, intracranial vasculopathy, or tissue sodium content were observed between groups. Gray matter CBF was elevated (P = 0.03) in patients with lipedema (57.2 ± 9.6 mL per 100 g/min) versus control participants (49.8 ± 9.1 mL per 100 g/min). CONCLUSIONS Findings provide evidence that brain sodium and tissue fractions are similar between patients with lipedema and control participants and that patients with lipedema do not exhibit abnormal radiological indicators of intracranial vasculopathy or ischemic injury. Potential explanations for elevated CBF are discussed in the context of the growing literature on lipedema symptomatology and vascular dysfunction.
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Affiliation(s)
- Kalen J. Petersen
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville TN, USA
- Corresponding author: Kalen J. Petersen, PhD, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21 Avenue South, Medical Center North AA-1105B, Nashville, TN 37232, USA, Tel: +1 615.343.7182, Fax: +1 615.322.0734,
| | - Maria Garza
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville TN, USA
| | - Paula M.C. Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville TN, USA
- Dayani Center for Health and Wellness, Vanderbilt University School of Medicine, Nashville TN, USA
| | - Kevin D. Harkins
- Biomedical Engineering, Vanderbilt University, Nashville TN, USA
| | - Adriana Marton
- Cardiovascular and Metabolic Disease, Duke-National University of Singapore Medical School
| | - Jens Titze
- Cardiovascular and Metabolic Disease, Duke-National University of Singapore Medical School
| | - Manus J. Donahue
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville TN, USA
- Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Rachelle Crescenzi
- Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville TN, USA
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30
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Abstract
Lipedema is a fat disorder that is often misdiagnosed. It was first identified at the Mayo Clinic in 1940, but medical schools do not include it in their curriculum and is therefore poorly understood. It presents as disproportionate and symmetrical accumulations of fat (bilateral), which is often accompanied by orthostatic edema. Early diagnosis and treatment are crucial, as the disease is progressive and can lead to immobility as well as a significant decrease in the quality of life. Lipedema differs from obesity because it does not respond to diet and exercise. This article gives you a glimpse into what lipedema is about and will help you identify some differences between lipedema and lymphedema. It will also help you identify which surgical procedures have been successful in treating the disease.
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Felmerer G, Stylianaki A, Hägerling R, Wang A, Ströbel P, Hollmén M, Lindenblatt N, Gousopoulos E. Adipose Tissue Hypertrophy, An Aberrant Biochemical Profile and Distinct Gene Expression in Lipedema. J Surg Res 2020; 253:294-303. [PMID: 32407981 DOI: 10.1016/j.jss.2020.03.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/29/2020] [Accepted: 03/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Lipedema is a common adipose tissue disorder affecting women, characterized by a symmetric subcutaneous adipose tissue deposition, particularly of the lower extremities. Lipedema is usually underdiagnosed, thus remaining an undertreated disease. Importantly, no histopathologic or molecular hallmarks exist to clearly diagnose the disease, which is often misinterpreted as obesity or lymphedema. MATERIALS AND METHODS The aim of the present study is to characterize in detail morphologic and molecular alterations in the adipose tissue composition of lipedema patients compared with healthy controls. Detailed histopathologic and molecular characterization was performed using lipid and cytokine quantification as well as gene expression arrays. The analysis was conducted on anatomically matched skin and fat tissue biopsies as well as fasting serum probes obtained from 10 lipedema and 11 gender and body mass index-matched control patients. RESULTS Histologic evaluation of the adipose tissue showed increased intercellular fibrosis and adipocyte hypertrophy. Serum analysis showed an aberrant lipid metabolism without changes in the circulating adipokines. In an adipogenesis gene array, a distinct gene expression profile associated with macrophages was observed. Histologic assessment of the immune cell infiltrate confirmed the increased presence of macrophages, without changes in the T-cell compartment. CONCLUSIONS Lipedema presents a distinguishable disease with typical tissue architecture and aberrant lipid metabolism, different to obesity or lymphedema. The differentially expressed genes and immune cell infiltration profile in lipedema patients further support these findings.
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Affiliation(s)
- Gunther Felmerer
- Division of Plastic Surgery, Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Aikaterini Stylianaki
- Division of Plastic Surgery, Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Rene Hägerling
- Molecular and Clinical Sciences Institute, St. George's University of London, London, United Kingdom; Institute of Medical and Human Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Wang
- Clinic of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Maija Hollmén
- MediCity Research Laboratory and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Nicole Lindenblatt
- Clinic of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Epameinondas Gousopoulos
- Division of Plastic Surgery, Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany; Clinic of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
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Wiedner M, Aghajanzadeh D, Richter DF. Lipödem – Grundlagen und aktuelle Thesen zum Pathomechanismus. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1109-5870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungDas Lipödem ist eine schmerzhafte, chronisch-fortschreitende Erkrankung, die durch eine symmetrische Unterhautfettgewebsvermehrung mit Flüssigkeitseinlagerung an den Beinen und/oder Armen gekennzeichnet ist. Durch Unkenntnis über das Krankheitsbild wird die Erkrankung häufig nicht erkannt oder fehlgedeutet. Eine korrekte Diagnostik und Behandlung ist jedoch wichtig, da die Prognose der Erkrankung beeinflusst werden kann. Eine kausale Therapie für das Lipödem ist nicht bekannt, da die genaue Ätiologie noch nicht vollständig geklärt ist. Aufgrund einer beschriebenen familiären Häufung der Erkrankung wird eine erbliche Komponente vermutet. Da das Lipödem fast ausschließlich bei Frauen auftritt und der Erkrankungsbeginn häufig mit Einsetzen von hormonellen Veränderungen in Zusammenhang steht (Pubertät, Schwangerschaft, Menopause), wird außerdem dem Östrogen eine entscheidende Bedeutung für die Entstehung zugemessen. In der vorliegenden Arbeit präsentieren wir einen Überblick über die Symptome und klinischen Merkmale des Lipödems, seine Differenzialdiagnosen, die Behandlungsmöglichkeiten und zuletzt die aktuellen Hypothesen zur Pathogenese des Lipödems.
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Affiliation(s)
- Maria Wiedner
- Dreifaltigkeitskrankenhaus Wesseling, Abteilung für Plastische Chirurgie, Wesseling
| | - Donia Aghajanzadeh
- Malteser Krankenhaus Seliger Gerhard Bonn/Rhein-Sieg, Plastische Chirurgie
| | - Dirk F. Richter
- Dreifaltigkeitskrankenhaus Wesseling, Abteilung für Plastische Chirurgie, Wesseling
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Increase in Leptin and PPAR-γ Gene Expression in Lipedema Adipocytes Differentiated in vitro from Adipose-Derived Stem Cells. Cells 2020; 9:cells9020430. [PMID: 32059474 PMCID: PMC7072543 DOI: 10.3390/cells9020430] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Lipedema is a painful loose connective tissue disorder characterized by a bilaterally symmetrical fat deposition in the lower extremities. The goal of this study was to characterize the adipose-derived stem cells (ASCs) of healthy and lipedema patients by the expression of stemness markers and the adipogenic and osteogenic differentiation potential. Forty patients, 20 healthy and 20 with lipedema, participated in this study. The stromal vascular fraction (SVF) was obtained from subcutaneous thigh (SVF-T) and abdomen (SVF-A) fat and plated for ASCs characterization. The data show a similar expression of mesenchymal markers, a significant increase in colonies (p < 0.05) and no change in the proliferation rate in ASCs isolated from the SVF-T or SVF-A of lipedema patients compared with healthy patients. The leptin gene expression was significantly increased in lipedema adipocytes differentiated from ASCs-T (p = 0.04) and the PPAR-γ expression was significantly increased in lipedema adipocytes differentiated from ASCs-A (p = 0.03) compared to the corresponding cells from healthy patients. No significant changes in the expression of genes associated with inflammation were detected in lipedema ASCs or differentiated adipocytes. These results suggest that lipedema ASCs isolated from SVF-T and SVF-A have a higher adipogenic differentiation potential compared to healthy ASCs.
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Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference. Dermatol Surg 2020; 46:220-228. [DOI: 10.1097/dss.0000000000002019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adipose Stem Cells from Lipedema and Control Adipose Tissue Respond Differently to Adipogenic Stimulation In Vitro. Plast Reconstr Surg 2020; 144:623-632. [PMID: 31461015 DOI: 10.1097/prs.0000000000005918] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lipedema is characterized by localized accumulation of fat in the extremities, which is typically unresponsive to dietary regimens or physical activity. Although the disease is well described and has a high incidence, little is known regarding the molecular and cellular mechanisms underlying its pathogenesis. The aim of this study was to investigate the pathophysiology of lipedema adipose cells in vitro. METHODS Adipose-derived stem cells were isolated from lipoaspirates derived from lipedema and nonlipedema patients undergoing tumescent liposuction. In vitro differentiation studies were performed for up to 14 days using adipogenic or regular culture medium. Supernatants and cell lysates were tested for adiponectin, leptin, insulin-like growth factor-1, aromatase (CYP19A1), and interleukin-8 content at days 7 and 14, using enzyme-linked immunosorbent assays. Adipogenesis was evaluated by visualizing and measuring cytoplasmic lipid accumulation. RESULTS Lipedema adipose-derived stem cells showed impeded adipogenesis already at early stages of in vitro differentiation. Concomitant with a strongly reduced cytoplasmic lipid accumulation, significantly lower amounts of adiponectin and leptin were detectable in supernatants from lipedema adipose-derived stem cells and adipocytes compared with control cells. In addition, lipedema and nonlipedema cells differed in their expression of insulin-like growth factor-1, aromatase (CYP19A1), and interleukin-8 and in their proliferative activity. CONCLUSIONS The authors' findings indicate that in vitro adipogenesis of lipedema adipose-derived stem cells is severely hampered compared with nonlipedema adipose-derived stem cells. Lipedema adipose cells differ not only in their lipid storage capacity but also in their adipokine expression pattern. This might serve as a valuable marker for diagnosis of lipedema, probably from an early stage on.
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36
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van de Pas CB, Boonen RS, Stevens S, Willemsen S, Valkema R, Neumann M. Does tumescent liposuction damage the lymph vessels in lipoedema patients? Phlebology 2019; 35:231-236. [PMID: 31674863 PMCID: PMC7178148 DOI: 10.1177/0268355519885217] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Lymphatic insufficiency might play a significant role in the pathophysiology
of lipoedema. Liposuction is up to now the best treatment. As liposuction is
invasive, the technique could destruct parts of the lymphatic system and by
this aggravate the lymphatic component and/or induce lymphoedema. We
investigated the function of the lymphatic system in lipoedema patients
before and after tumescent liposuction and thus whether tumescent
liposuction can be regarded as a safe treatment. Methods Lymphoscintigraphy was performed to quantify the lymph outflow of 117
lipoedema patients. Mean clearance percentages of radioactive protein loaded
after 1 min with respect to the total injected dose and corrected for decay
of the radiopharmaceutical in the subcutaneous lymphatics were used as
functional quantitative parameters as well as the clearance percentages and
inguinal uptake 2 h post injection. The results of lymphatic function in
lipoedema patients were compared with values obtained from normal healthy
volunteers. We also compared 50 lymphoscintigraphies out of the previous 117
lipoedema patients before and six months after tumescent liposuction. Results In 117 lipoedema patients clearance 2 h post injection in the right and left
foot was disturbed in 79.5 and 87.2% respectively. The inguinal uptake 2 h
post injection in the right and left groin was disturbed in 60.3 and 64.7%
respectively. In 50 lipoedema patients mean clearance and inguinal uptake
after tumescent liposuction were slightly improved, 0.01 (p = 0.37) versus
0.02 (p = 0.02), respectively. This is statistically not relevant in
clearance. Conclusion Lipoedema legs have a delayed lymph transport. Tumescent liposuction does not
diminish the lymphatic function in lipoedema patients, thus tumescent
liposuction can be regarded as a safe treatment.
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Affiliation(s)
- Chantalle B van de Pas
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.,Polikliniek de Blaak, Rotterdam, The Netherlands.,Kliniek De Medici, Blaricum, The Netherlands
| | | | | | - Sten Willemsen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Roelf Valkema
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martino Neumann
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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37
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Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L. Lipedema: A Call to Action! Obesity (Silver Spring) 2019; 27:1567-1576. [PMID: 31544340 PMCID: PMC6790573 DOI: 10.1002/oby.22597] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/30/2019] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Giacomo Buso
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Michele Depairon
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Didier Tomson
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Wassim Raffoul
- Plastic Surgery Division, Locomotor System DepartmentLausanne University HospitalLausanneSwitzerland
| | - Roberto Vettor
- Department of Medicine, Center for the Study and the Integrated Management of Obesity (EASO COM)Padova University HospitalPadovaItaly
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
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An approach to lipedema: a literature review of current knowledge of an underestimated health problem. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01519-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Lipedema is a fat disorder that is often misdiagnosed. It was first identified at the Mayo Clinic in 1940, but medical schools do not include it in their curriculum and is therefore poorly understood. It presents as disproportionate and symmetrical accumulations of fat (bilateral), which is often accompanied by orthostatic edema. Early diagnosis and treatment are crucial, as the disease is progressive and can lead to immobility as well as a significant decrease in the quality of life. Lipedema differs from obesity because it does not respond to diet and exercise. This article gives you a glimpse into what lipedema is about and will help you identify some differences between lipedema and lymphedema. It will also help you identify which surgical procedures have been successful in treating the disease.
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Forner-Cordero I, Oliván-Sasot P, Ruiz-Llorca C, Muñoz-Langa J. Hallazgos linfogammagráficos en pacientes con lipedema. Rev Esp Med Nucl Imagen Mol 2018; 37:341-348. [DOI: 10.1016/j.remn.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
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Forner-Cordero I, Oliván-Sasot P, Ruiz-Llorca C, Muñoz-Langa J. Lymphoscintigraphic findings in patients with lipedema. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Reich-Schupke S, Schmeller W, Brauer WJ, Cornely ME, Faerber G, Ludwig M, Lulay G, Miller A, Rapprich S, Richter DF, Schacht V, Schrader K, Stücker M, Ure C. S1-Leitlinie Lipödem. J Dtsch Dermatol Ges 2018; 15:758-768. [PMID: 28677176 DOI: 10.1111/ddg.13036_g] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Die vorliegende überarbeitete Leitlinie zum Lipödem wurde unter der Federführung der Deutschen Gesellschaft für Phlebologie (DGP) erstellt und finanziert. Die Inhalte beruhen auf einer systematischen Literaturrecherche und dem Konsens von acht medizinischen Fachgesellschaften und Berufsverbänden. Die Leitlinie beinhaltet Empfehlungen zu Diagnostik und Therapie des Lipödems. Die Diagnose ist dabei auf der Basis von Anamnese und klinischem Befund zu stellen. Charakteristisch ist eine umschriebene, symmetrisch lokalisierte Vermehrung des Unterhautfettgewebes an den Extremitäten mit deutlicher Disproportion zum Stamm. Zusätzlich finden sich Ödeme, Hämatomneigung und eine gesteigerte Schmerzhaftigkeit der betroffenen Körperabschnitte. Weitere apparative Untersuchungen sind bisher besonderen Fragestellungen vorbehalten. Die Erkrankung ist chronisch progredient mit individuell unterschiedlichem und nicht vorhersehbarem Verlauf. Die Therapie besteht aus vier Säulen, die individuell kombiniert und an das aktuelle Beschwerdebild angepasst werden sollten: komplexe physikalische Entstauungstherapie (manuelle Lymphdrainage, Kompressionstherapie, Bewegungstherapie, Hautpflege), Liposuktion und plastisch-chirurgische Interventionen, Ernährung und körperliche Aktivität sowie ggf. additive Psychotherapie. Operative Maßnahmen sind insbesondere dann angezeigt, wenn trotz konsequent durchgeführter konservativer Therapie noch Beschwerden bestehen bzw. eine Progredienz des Befundes und/oder der Beschwerden auftritt. Eine begleitend zum Lipödem bestehende morbide Adipositas sollte vor einer Liposuktion therapeutisch angegangen werden.
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Affiliation(s)
| | | | | | | | | | - Malte Ludwig
- Gefäßzentrum, Benedictus Krankenhaus Tutzingen GmbH & Co. KG, Tutzingen
| | - Gerd Lulay
- Gefäß- und Lymphzentrum Nord-West am Mathias-Spital, Rheine
| | | | | | | | - Vivien Schacht
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Klaus Schrader
- FA für Allgemeinmedizin, Phlebologie, Lymphologe BVL/DGL(TM)
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum
| | - Christian Ure
- Lymphklinik Wolfsberg, Landeskrankenhaus Wolfsberg, Österreich
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Reich-Schupke S, Schmeller W, Brauer WJ, Cornely ME, Faerber G, Ludwig M, Lulay G, Miller A, Rapprich S, Richter DF, Schacht V, Schrader K, Stücker M, Ure C. S1 guidelines: Lipedema. J Dtsch Dermatol Ges 2018; 15:758-767. [PMID: 28677175 DOI: 10.1111/ddg.13036] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. 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.
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Affiliation(s)
| | | | | | | | - Gabriele Faerber
- Vascular Center, Benedictus Hospital Tutzingen GmbH & Co. KG, Tutzingen, Germany
| | - Malte Ludwig
- Center for Vascular and Lymphatic Medicine Nord-West at the Mathias Hospital, Rheine, Germany
| | | | | | - Stefan Rapprich
- Plastic Surgery Unit, Dreifaltigkeits-Krankenhaus University Teaching Hospital Wesseling, Germany
| | - Dirk Frank Richter
- Department of Dermatology, Allergology, and Venereology, Hanover Medical School, Hanover, Germany
| | - Vivien Schacht
- Board-certified in General Medicine, Phlebology, Lymphology BVL/DGL(TM)
| | - Klaus Schrader
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Germany
| | - Markus Stücker
- Institute for Vascular Medicine, Recklinghausen, Germany
| | - Christian Ure
- Wolfsberg Clinical Center for Lymphatic Disorders, Wolfsberg State Hospital, Austria
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Shavit E, Wollina U, Alavi A. Lipoedema is not lymphoedema: A review of current literature. Int Wound J 2018; 15:921-928. [PMID: 29956468 DOI: 10.1111/iwj.12949] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/19/2018] [Indexed: 12/15/2022] Open
Abstract
Lipoedema is a rare painful disorder of the adipose tissue. It essentially affects females and is often misdiagnosed as lymphoedema or obesity. It is globally misdiagnosed or underdiagnosed, and the literature is lacking appropriate guidance to assist clinicians towards this diagnosis. However, the need to recognise this disorder as a unique entity has important implications to establish proper treatment and, therefore, its tremendous effect on patients. Early diagnosis and treatment can turn these patients' lives upside down. The aim of this review is to focus on the clinical guidance, differential diagnosis, and management strategies. In addition, other aspects of lipoedema, including epidemiology and pathogenesis, are also being discussed here. Lipoedema is distinct from obesity and distinct from lymphoedema, although it might progress to involve the venous and lymphatic system (venolipedema or lympholipedema or both). Late diagnosis can leave the patient debilitated. Management of lipoedema includes weight loss, control of oedema, complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. However; there are increasing reports on tumescent liposuction as the preferred surgical option with long-lasting results. The role of more randomised controlled studies to further explore the management of this clinical entity remains promising.
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Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Romeijn JRM, de Rooij MJM, Janssen L, Martens H. Exploration of Patient Characteristics and Quality of Life in Patients with Lipoedema Using a Survey. Dermatol Ther (Heidelb) 2018; 8:303-311. [PMID: 29748843 PMCID: PMC6002318 DOI: 10.1007/s13555-018-0241-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lipoedema is a chronic disorder in which excessive fat distribution occurs predominantly from the waist down, resulting in a disproportion between the lower extremities and upper torso. Lipoedema is often not recognized, while patients experience pain and easy bruising. As a long-term condition, lipoedema has a massive effect on patients' lives and mental health. The aim of this study is to explore patient characteristics, quality of life, physical complaints and comorbidities in patients with lipoedema. METHODS A survey was conducted by email amongst lipoedema patients, consisting of informed consent and multiple questionnaires. The questionnaires included general patient characteristics, physical complaints, comorbidities, RAND-36 and EQ-5D-3L. Participants who responded to a message on the Dutch Lipoedema Association website were recruited. RESULTS All lipoedema patients experience physical complaints, with pain (88.3 %) and easy bruising (85.9 %) as primary complaints. The diagnosis was mostly made by a dermatologist after visiting a mean of 2.8 doctors. Furthermore, mean time from onset until diagnosis was 18 years. Quality of life (59.3) was significantly lower than the Dutch female average (74.9; p < 0.001). Additionally, patients with comorbidities had significant lower quality of life (RAND 54.7, p < 0.001). CONCLUSIONS Lipoedema patients often have severe complaints and experience lower quality of life regarding physical, emotional and social functioning. Additionally, comorbidities have a large impact on quality of life.
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Affiliation(s)
- Jeroen R M Romeijn
- Department of Dermatology, VieCuri Medical Centre, Venlo, The Netherlands.
| | | | - Loes Janssen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Herm Martens
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Depairon M, Tomson D, Lessert C, Mazzolai L. [Lipedema, the Unknown]. PRAXIS 2018; 107:1071-1076. [PMID: 30278840 DOI: 10.1024/1661-8157/a003088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lipedema, the Unknown Abstract. Lipoedema patients suffer from the widespread ignorance of their pathology. Considering its chronic, progressive and invalidating character, the early diagnosis of the disease must constitute the challenge of their caregivers in order to limit medical wanderings and the occurrence of complex clinical pictures. Treatments allow the reduction of lipedema and its long-term control. Management must be individualized according to the stage of the disease. The adherence of the patient, the supervision and the support of the practitioner are essential for obtaining the best results.
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Affiliation(s)
- Michèle Depairon
- 1 Médecin-adjoint, PD&MER, Service d'Angiologie, Centre Hospitalier Universitaire Vaudois (CHUV)
| | - Didier Tomson
- 1 Médecin-adjoint, PD&MER, Service d'Angiologie, Centre Hospitalier Universitaire Vaudois (CHUV)
| | - Claudia Lessert
- 1 Médecin-adjoint, PD&MER, Service d'Angiologie, Centre Hospitalier Universitaire Vaudois (CHUV)
| | - Lucia Mazzolai
- 2 Département Cœur et Vaisseaux, Centre Hospitalier Universitaire Vaudois (CHUV)
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Abstract
Lipoedema is a chronic progressive adipose disorder that affects mainly women and presents as symmetrical enlargement of the buttocks and legs. It is commonly misdiagnosed as obesity or lymphoedema, but careful assessment will reveal a disproportionate enlargement below the waist which is resistant to dieting, sparing of the feet, legs are tender or painful to touch and bruise easily, there is occasional orthostatic oedema, and there is often significant psychological morbidity. Lipoedema is a oestrogen-regulated condition with onset around puberty in 78% of women, and there is often a strong family history. The condition is exacerbated by weight gain and there is increasing anecdotal evidence that women who are obese are seeking a diagnosis of lipoedema, either to procure NHS funded manual lymphatic drainage, or to medicalise their obesity and avoid acknowledging that the responsibility for their weight gain is lifestyle orientated. Management of lipoedema consists of accurate diagnosis, psychological care, management of orthostatic oedema, and prevention of progression through skin care and weight management.
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Affiliation(s)
- Marie Todd
- Clinical Nurse Specialist in Lymphoedema, Glasgow Specialist Lymphoedema Service, Glasgow, Scotland
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Abstract
Lipedema is an uncommon disorder characterized by localized adiposity of the lower extremities, often occurring in females with a family history of the condition. The adiposity extends from hips to ankles and is typically unresponsive to weight loss. In addition to the aesthetic deformity, women also describe pain in the lower extremities, particularly with pressure, as well as easy bruising. Although the condition is well described, it is relatively rare and often misdiagnosed. The purpose of this review is to describe the initial evaluation and diagnosis of lipedema and discuss treatment options.
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Affiliation(s)
- Anne Warren Peled
- Private Plastic and Reconstructive Surgery Practice, San Francisco, CA, USA
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
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Halk AB, Damstra RJ. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. Phlebology 2016; 32:152-159. [DOI: 10.1177/0268355516639421] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction Lipedema is a chronic, progressive condition that can result in considerable disability. In 2011, the Dutch Society of Dermatology and Venereology organized a task force to create guidelines on lipedema, using the International Classification of Functioning, Disability and Health of the World Health Organization. Guideline development Clinical questions on significant issues in lipedema care were proposed, involving (1) making the diagnosis of lipedema; (2) clinimetric measurements for early detection and adequate follow-up; and (3) treatment. A systematic review of literature published up to June 2013 was conducted. Based on available evidence and experience of the task force, answers were formed and recommendations were stated. The guidelines define criteria to make a medical diagnosis of lipedema, a minimum data set of (repeated) clinical measurements that should be used to ensure early detection and an individually outlined follow-up plan, pillars on which conservative treatment should be based and recommendations on surgical treatment options. Conclusions Little consistent information concerning either diagnostics or therapy can be found in the literature. It is likely that lipedema is frequently misdiagnosed or wrongly diagnosed as only an aesthetic problem and therefore under- or mis-treated. Treatment is divided into conservative and chirurgic treatment. The only available technique to correct the abnormal adipose tissue is surgery. Recommendations To ensure early detection and an individually outlined follow-up, the committee advises the use of a minimum data set of (repeated) measurements of waist circumference, circumference of involved limbs, body mass index and scoring of the level of daily practice and psychosocial distress. Promotion of a healthy lifestyle with individually adjusted weight control measures, graded activity training programs, edema reduction, and other supportive measures are pillars of conservative therapy. Tumescent liposuction is the treatment of choice for patients with a suitable health profile and/or inadequate response to conservative and supportive measures.
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Affiliation(s)
- Anne B Halk
- Department of Dermatology, Leiden University Medical Centre (LUMC), The Netherlands
| | - Robert J Damstra
- Dutch Expertise Centre of Lympho-vascular Medicine, Hospital Nij Smellinghe, Drachten, The Netherlands
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Abstract
The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things.
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Affiliation(s)
- Valencia Long
- Department of General Medicine, National University Hospital, Singapore
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