Recognize and treat lipedema
Wide hips, thick thighs and in addition a slim or normal upper body – these physical appearances are sometimes not just the famous “few kilos too much”, but they can indicate a serious disease. How to recognize and treat lipedema.
What exactly is lipedema? Lipedema is a progressive disease of the subcutaneous fatty tissue that mostly affects women and for which there is no cure yet. Once lipedema has been diagnosed, it can be treated, and there are various treatment methods.
The onset of the disease is often associated with hormonal changes such as puberty or pregnancy. Lipedema is rarely diagnosed before or after menopause.
A familial clustering, for example a disease of mother and daughter, can be observed in some cases. Sometimes, however, generations are skipped. Men are also under discussion as inheritors of the apparently hormonally driven genetic defect.
Recognizing lipedema: The fatty tissue changes during the course of the disease. A symmetrical, spongy and riding-pants-like increase in fatty tissue is seen. As the disease progresses, the so-called “mattress phenomenon” develops. The skin surface becomes wavy and nodules form in thickened areas of skin that can become as large as walnuts or apples. The increasing disproportion between the trunk, arms and legs is striking.
Lipedema vs Obesity
Unlike other fat distribution disorders such as obesity or adipose tissue proliferation (lipohyperplasia), lipedema patients suffer from pressure and touch pain and bruise very quickly. Hands and feet, on the other hand, are not affected in lipedema.
If left untreated, fatty tissue gain and the resulting strain on the lymphatic system can cause secondary lymphedema, or lipolymphedema, to develop over the years. Our lymphatic system is the second most important transport system besides the blood circulation. The additional stress caused by fatty tissue impairs the function of the vascular walls and reduces their transport capacity.
As a result, the lymphatic system can no longer fully perform its function of ensuring fluid balance in the body and transporting excess fluids, including substances requiring lymphatic drainage such as fats, viruses, bacteria, proteins, cells and cell debris, out of the tissues. Affected patients therefore suffer from heavy and swollen arms and legs in addition to the increase in fatty tissue. In addition, they experience a tension or bursting pain.
A classification system has been developed for lipedema that uses four stages in its most common manifestation:
Stage I: smooth skin surface, subcutaneous fat thickened, adipose tissue structure finely nodular.
Stage II: uneven skin surface, fatty tissue structure coarsely nodular and clearly visibly increased Stage III: tissue additionally coarser and harder, large-lobed deforming and overhanging fat lobes (knee/elbow)
Stage IV: additionally manifested lymphedema (elephantiasis)
The stages merge smoothly into one another and can develop over years. Due to the hormonal component of the disease, the process can accelerate significantly in the event of hormonal fluctuations (e.g. due to pregnancy).
Later stages also have far-reaching health influences. Among other things, axial deformities and arthrosis are observed due to the extensive fat and thus weight gain. Eating disorders and depression may also be sequelae.
In addition to the stages, there is also a type classification, which mainly refers to the localization of the fatty tissue changes.
Type 1: buttocks and hips (formation of the so-called saddlebags).
Type 2: buttocks, hips, thighs
Type 3: buttocks, hip, upper and lower leg
Type 4: arms and legs are affected
Often, type 5 is additionally defined as the lipolymphedema already mentioned above.
Both stages and types are used to assess the individual disease pattern and associated symptoms. According to these, a patient may have lipedema type 3, for example, in which the vessel, hips, and entire leg are affected. However, the stage of the disease may be II. This means that the fatty tissue structure in the affected areas presents as coarse nodular and significantly increased, the skin surface as uneven and deltoid.
The disadvantage with the classifications is that pain, as a major symptom of lipedema, has not been considered at all in the diagnosis so far. For this reason, a new score has recently been discussed, the MLS-Munich Lipedema Score, which, among other things, also depicts the pain burden of affected patients and can therefore serve to confirm the diagnosis.
This extension is also useful because it has a decisive influence on the necessary therapy. If conservative measures such as lymphatic drainage and compression are not sufficient to alleviate the symptoms, liposuction can be considered even in early stages. This has emerged as the decisive and most sustainable measure for improving the quality of life.