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magazine 2012/1
Clinical pictures: Dr. Herpertz/
Lipedema is a frequently misdiagnosed and misunderstood fat distribution disorder,
which almost exclusively affects women. Treatment success, however, requires in-depth
knowledge of the condition. An article by Joyce Bosman.
The misunderstood edema
Lipedema: the basics
Various factors are blamed for causing li-
pedema, including hormonal influences and
a genetic predisposition. Lipedema gener-
ally occurs during puberty or pregnancy.
The condition follows a chronic, progressive
course and is sometimes associated with a
secondary lymph drainage impairment lead-
ing to lipo-lymphedema.
The clinical picture varies with the site of
the fatty tissue affected: type 1, mainly the
buttocks area; type 2, between the buttocks
area and the knees; type 3, between the but-
tocks area and the ankles; type 4, mainly on
the arms; type 5, lipo-lymphedema. Meier-
Vollrath and Schmeller have defined three
stages of lipedema: stage I, macroscopically
smooth skin with an evenly micronodular
and thickened subcutaneous layer; stage II,
enlarged nodes with uneven areas of surface
skin like orange peel; stage III, increasingly
indurated subcutaneous tissue with well-
circumscribed lobes of fat.
Discrepancy between torso and
lower extremities
Lipedema is characterized by a bilateral and
symmetrical increase in volume affecting
the legs, as well as by pain, soreness under
pressure, susceptibility to hematomas, and
fluid volumes persisting even after eleva-
tion of affected limbs or weight has been
lost. Most patients have normal upper
body proportions, which means there is a
considerable discrepancy between the torso
Lipedema is characterized by a bilateral and symmetrical increase in
volume affecting the legs.
Lymphedema are often asymmetrical.