Lipoedema

What is lipoedema?

Big legs, protruding buttocks – often, lipoedema is wrongly judged as being overweight or obese.

But lipoedema has nothing to do with being overweight. Lipoedema is the result of a pathological build-up of fat cells in the extremities. Typically, it affects the legs. Since lipoedema occurs almost exclusively in women, experts assume hormonal causes.

Despite a conscious diet and exercise, the affected women typically gain weight in their legs and/or, less commonly, arms. The increased accumulation of fat cells cannot be reduced by calorie reduction.  

What is the cause of lipoedema?

There is no exhaustive research on lipoedema yet. One thing is certain though: This chronic disease is not caused by improper nutrition or excessive food intake. Experts presume a genetic predisposition as well as hormonal triggers.

Lipoedema often starts during puberty. However, oral contraceptive use, pregnancy, and menopause also seem to be triggers. In men, lipoedema-like changes have only been described in the context of hormonally active therapeutic agents, pronounced hormone imbalances (for example, hypogonadism), or liver cirrhosis.

What are the signs and symptoms of lipoedema?

• Considerable tissue enlargement; usually bilateral and symmetrical without involvement of the hands and feet. The pattern of affected areas may vary from patient to patient. It most commonly affects the legs, thighs, hips, and/or buttocks, but it can also affect the arms.
• Pain and extreme sensitivity/tenderness to touch and pressure in the affected areas.
• Swelling and feeling of heaviness in the affected limbs.
• Limited mobility, muscle weakness.
• Cuffing or “braceleting” at the ankles/wrists: The tissue enlargement stops abruptly at the ankles or wrists so that there is a “step” before the feet or hands which are usually unaffected.
• In lower-limb lipoedema, loss of the concave spaces on either side of the Achilles tendon.
• Tendency to easily bruise: May occur anywhere in areas affected by lipoedema without any apparent cause.
• Altered skin appearance, temperature, and texture: Softer and cooler skin in comparison to unaffected areas; texture of orange peel or with larger dimples.
• Abnormal gait, limited mobility, and muscle weakness.
• Stemmer’s sign is negative. This means that a fold of skin can be pinched and lifted up at the base of the second toe or at the base of the middle finger.
• Pitting oedema (in patients with lipoedema or lipo-lymphoedema and/or CVI): Usually absent in the early stages; indicates the presence of excess interstitial fluid.

The stages of lipoedema

Experts divide lipoedema into three stages. Symptoms of lipoedema can vary greatly from person to person – not all patients, for example, reach stage III.

Stage I: The skin appears smooth. If pressed on, uniformly thickened subcutaneous tissue with soft consistency.

Stage II: The skin shows an irregular texture that resembles the skin of an orange. Subcutaneous nodules that vary in size are palpable.

Stage III: The volume increase of the subcutaneous fat tissue has progressed further with larger and more prominent indurations than in stage II. Deformed lobular fat deposits that may cause considerable distortion of the limb profile are present.

Can I prevent lipoedema?

Since the causes of lipoedema have not been conclusively determined, there are no preventive measures either.

Weight can aggravate the symptoms and favor the progression of the disease, therefore a healthy diet may have a positive influence.

Summary

Lipoedema is a chronic, progressive fat tissue distribution disorder almost exclusively in women.

Basic medical knowledge on lipoedema

• Clinically, lipoedema is characterized by abnormal distribution of adipose tissue, resulting in pronounced disproportion between extremities and trunk.
• Said disproportion is caused by a localised, symmetrical increase in subcutaneous adipose tissue, typically in the lower extremities and less often in the upper extremities.
• Other findings include pain and extreme sensitivity/tenderness to touch and pressure in the affected areas, oedema (aggravated by orthostasis), and easy bruising following minor trauma.