Lipoedema: from clinical presentation to therapy. Further aspects

Survey of lipoedema symptoms and experience with compression garments

Lipoedema is an incurable chronic disease causing limb deformity, painful skin and excessive ecchymosis. Compression garments are frequently recommended to manage symptoms, but the existing products are not designed specifically for lipoedema, and are for other medical conditions. A structured questionnaire was prepared in Online Surveys in October 2018 to investigate lipoedema symptoms and the use of compression garments to manage them. Some 279 people with lipoedema completed the survey; 70% wore compression garments in all four compression classes, of which class 2 was most common (58% of wearers). The top three reasons for wearing compression garments were to feel supported (73%), reduce lipoedema pain (67%) and improve mobility (54%). Most people with lipoedema who wore compression garments found compression helpful in managing their symptoms, but overall satisfaction was low. Problems with existing compression garments were so severe in some cases that the garments were not worn at all or used less often. The information collected in this survey might be useful for the design and development of compression garments specifically for lipoedema.

Exploration of Patient Characteristics and Quality of Life in Patients with Lipoedema Using a Survey

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.

Treatment of lipoedema using liposuction

Hintergrund: Beim Lipödem handelt es sich um eine schmerzhafte, anlagebedingt übermäßige Fettgewebsvermehrung der Extremitäten bei Frauen. Die Ursache ist unbekannt. Ebenso unbekannt ist die Zahl der betroffenen Frauen in Deutschland. Eine eigene Untersuchung zur Epidemiologie wird vorgestellt. Als Therapiemöglichkeit stehen die Komplexe Physikalische Entstauungstherapie und die Liposuktion zur Verfügung. Nur durch die Liposuktion ist eine dauerhafte Entfernung des Fettgewebes möglich. Ihre Wirksamkeit wird in einer weiteren Untersuchung aufgezeigt und die Bedeutung als Teil eines umfassenden Behandlungskonzeptes dargelegt.

Patienten und Methodik: Für die epidemiologische Untersuchung wurden in einer ländli-chen Hausarztpraxis sämtliche Patientinnen bezüglich Beinleiden untersucht. Die Studie zur Liposuktion umfasste die prä- und postoperative Untersuchung von 85 Patientinnen mittels Beschwerdefragebogen.

Ergebnisse: Bei 5 % aller Patientinnen einer Hausarztpraxis wurde ein Lipödem festgestellt. Mittels Liposuktion konnten bei 85 Patientinnen Schmerzen, Druckschmerz, Hämatomneigung und Schwellungsneigung signifi-kant vermindert und die Lebensqualität verbessert werden.

Schlussfolgerung: Das Lipödem ist eine relativ häufige Erkrankung der weiblichen Bevölkerung. Die Liposuktion stellt zusammen mit der prä- und postoperativen komplexen physikalischen Entstauungstherapie, einem Sportprogramm und der Behandlung einer begleitenden Adipositas sowie bedarfsweise einer psychologischen Unterstützung ein wirksames Behandlungskonzept dar.

Sie kann nur im Zusammenwirken mit diesen anderen Therapien erfolgreich sein und daher ist ein umfassender Therapieplan anzustreben.

[Recognising and treating lipidema OMIM 614103]

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

Lipedema: an overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review

Lipedema is a disproportionate, symmetrical fatty swelling characterized by pain and bruising existing almost exclusively among women. We undertook a systematic review of the available literature about lipedema, given the lack of knowledge and little evidence about this disorder especially among obesity experts. Diagnosis of lipedema is usually based on clinical features. Symmetrical edema in the lower limbs with fatty deposits located to hips and thighs usually appears at puberty and often affects several members of the same family. Main disorders considered for differential diagnosis are lymphedema, obesity, lipohypertrophy and phlebedema. Treatment protocols comprise conservative (decongestive lymphatic therapy) and surgical (liposuction) approaches. Early diagnosis and treatment are mandatory for this disorder otherwise gradual enlargement of fatty deposition causes impaired mobility and further comorbidities like arthrosis and lymphatic insufficiency.