Lipedema is a condition characterized by the abnormal deposition of adipose tissue, typically in the hips, thighs and legs, but stopping before the feet. It can also appear in the upper arms. Lipedema can be very painful, and often leads to capillary fragility, making patients more prone to easy bruising. This condition is also unique to women, often inherited and more common than we think. It is expected that it often goes undiagnosed and is written off as just obesity. “Making the diagnosis relies on some of the hallmark characteristics of lipedema, such as the easy bruising and pain with soft tissue pressure, as well as the step-off at the ankles. Women with generalized obesity typically do not have these history and physical exam characteristics.” (Warren Peled, A. & Kappos, E., 2016).
Lipedema can also be confused for lymphedema, or chronic venous insufficiency. Although these conditions are different and a proper diagnosis is important, they are greatly intertwined and often occur together. In these cases, both conditions need to be considered and treated.
Lipedema is a chronic and incurable disease that requires lifetime maintenance and treatment. Treatment for lipedema still requires ongoing research as we currently do not fully understand the pathophysiology of the disease. Some of the current known therapies to help lipedema can be classified into 2 main categories: conservative treatment and surgical treatment.
Conservative therapies are primarily focused on improving strength, fitness and improving overall health habits. One of these therapies is a change in diet. As mentioned previously lipedema is not simply obesity and when talking about diet it can be a touchy subject as many women with this condition are told numerous times they “just need to eat better and lose weight”. This is an incorrect thinking process as lipedema is actually a complex disease and dietary changes alone will not cure the abnormal adipose tissue deposition. Diet can however greatly reduce inflammation and help ease the pain that is often experiences by those with lipedema (Warren Peled, A. & Kappos, E., 2016). In addition to dietary modifications, it has been demonstrated that physiotherapy is of great benefit to those with lipedema. “The current review [of literature] showed that complex decongestive physiotherapy, gait training, hydrotherapy, aerobic exercise, and resistance exercise training each have value in the management of lipedema.” (Esmer, M. U. R. A. T., Schingale, F. J., Unal, D. A. M. L. A., & Güzel, N. A., 2020). In research completed by Szolnoky, G. et al in 2008 it was observed that complete decongestive physiotherapy significantly reduced capillary fragility inpatients with lipedema and it is theorized that this reduction may lead to reduced hematoma formation. Combined, these therapies can often greatly improve function and quality of life.
In cases of non-response or limited response to conservative therapies, surgical options may be considered. Surgical options can be greatly beneficial to help improve quality of life, but it should be noted that they are not curative and carry risks (Warren Peled, A. & Kappos, E., 2016).
Increased recognition and diagnosis can help lead to earlier interventions and timely access to conservative therapies. This complex medical condition requires lifelong monitoring and varying intervention. In order to optimize treatment for patients in all stages of lipedema, more research is required.
References:
Esmer, M. U. R. A. T., Schingale, F. J., Unal, D. A. M. L. A., & Güzel, N. A. (2020). Physiotherapy and rehabilitation applications in lipedema management: A literature review. Lymphology, 53(2), 88-95.
Szolnoky, G., Nagy, N., Kovács, R. K., Dósa-Rácz, E., Szabó, A., Bársony, K., … & Kemény, L. (2008). Complex decongestive physiotherapy decreases capillary fragility in lipedema. Lymphology, 41(4), 161-166.
Warren Peled, A. & Kappos, E. A. (2016) Lipedema: diagnostic and management challenges, International Journal of Women’s Health, 8:, 389-395, DOI: 10.2147/IJWH.S106227