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Lipoedema: what is behind legs that won’t slim?

Lipoedema is a complex topic, not only because of the lack of basic research on the subject, but also because of the abundance of misinformation that floods the internet and the hundreds of “miracle treatments” with no scientific evidence to support them. Although the causes of this condition have not been identified, current research suggests it has a multifactorial origin with genetic and hormonal implication that affects almost exclusively females. However, lipoedema remains greatly unknown among the professionals themselves [1].


A disorder with a name not entirely accurate given a true oedema does not manifest in all cases. More specifically, lipoedema is characterized by an abnormal proliferation of the adipocytes. The normal structure of the fat tissue consists of microlobules and lobules. During lipoedema development, adipocytes accumulate in macrolobules. Without a clear scientific definition, it finds itself stuck at the border of being considered a disease due to the absence of an agreement on whether it fits all the criteria [1].


Lipoedema could be defined as a chronic disorder of the adipose tissue that appears during puberty and hardly responds to strategies such as diet or physical exercise. Visually, people affected by lipoedema are characterized by a normal or thin trunk in contrast to thick legs, giving the sensation that two different bodies “have stuck together” in the same person. Fat accumulates bilaterally and symmetrically, especially in the lower limbs and rarely in the upper limbs. Leaving aesthetics aside, lipoedema also has a negative impact on people's quality of life as they experience additional unpleasant symptoms such as tenderness to palpation, considerable pain, ecchymosis and/or exaggerated hematomas, without forgetting the psychological and emotional impact due to the importance of physical appearance in nowadays society [1].


It should be noted that lipoedema is often confused with other conditions such as lymphedema, obesity, and cellulites [4]. Therefore, it is of utmost importance to consider the basic clinical-epidemiological characteristics of each one to be able to carry out a proper diagnosis [1,2].

Table 1: Basic clinical-epidemiological characteristics of lipoedema, lymphedema, obesity and cellulites[1]


The clinical diagnosis of lipoedema is essentially based on anamnesis and physical examination of the patient. Unfortunately, misdiagnosis appears to be the rule rather than the exception, mainly because of shortage of information and unawareness of the disease. Moreover, there is no adequate classification of lipoedema, and the existing guidelines are insufficient and not universally accepted. One of the most broadly applied is the Classification of Schingale [1,3].

Table 2: Classification of Schingale[1,6]


As of today, a curative treatment for lipoedema does not exist. Fortunately, there are excellent professionals who can help treat it. General strategies focus on pain relief and reduction of disproportionate swelling. To proceed, the first recommendation is to characterize the pain using a validated scale such as the "Douleur Neuropathique-4" [1]. Based on the severity of the pain and the extend of the swelling, different pharmacological and physical approaches can be used. A combination of drugs such as analgesics, anticonvulsants (gabapentin) and antidepressants as well as treatments like manual lymphatic drainage, compression therapy and tumescent liposuction have proven to have a positive effect on general health status [1,5].


Likewise, pathological conditions such as overweight and the rising index of obesity worldwide are not only closely associated with lipoedema, but also aggravate it. Lifestyle counselling, weight management and exercise regimens must be followed more strictly than ever by those diagnosed with the condition [1]. Personalized diet with the objective of not increasing caloric intake to maintain a normal weight and regular exercise (avoiding impact sports such as kickboxing to minimize the appearance of hematomas due to capillary fragility) will not only reduce the complications and symptoms of people with lipoedema but will also have a positive impact on their daily life [7].


References:

2. Arias-Cuadrado, A. et al. (2010) “Clínica, Clasificación y Estadiaje del Linfedema,” Rehabilitación, 44, pp. 29–34. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0048712010001192?via%3Dihub

3. Forner-Cordero, I., Cuello-Villaverde, E. and Forner-Cordero, A. (2010) “Linfedema: Diagnóstico diferencial Y pruebas complementarias,” Rehabilitación, 44, pp. 14–20. Available at: https://doi.org/10.1016/j.rh.2010.05.007

4. Herbst, K.L. (2012) “Rare adipose disorders (RADS) masquerading as obesity,” Acta Pharmacologica Sinica, 33(2), pp. 155–172. Available at: https://doi.org/10.1038/aps.2011.153.

5. Schlosshauer, T. et al. (2021) “Liposuction treatment improves disease‐specific quality of life in lipoedema patients,” International Wound Journal, 18(6), pp. 923–931. Available at: https://onlinelibrary.wiley.com/doi/10.1111/iwj.13608

6. Tipos y grados de lipedema (2022) Clinica Simarro. Available at: https://clinicasimarro.com/que-es-el-lipedema/tipos-y-grados-de-lipedema/

7. Witkowska, A. et al. (2021) “The effects of Nordic walking compared to conventional walking on aerobic capacity and lipid profile in women over 55 years of age,” Journal of Physical Activity and Health, 18(6), pp. 669–676. Available at: https://doi.org/10.1123/jpah.2020-0182

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