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magazine 2012/1
consensus as to which compression class to
use from the most common classification.
On an international level, recommenda-
tions are split between class 1 or 2 for the
purposes of compression treatment. A more
intense form of compression therapy is less
suitable for lipedema than for venous condi-
tions or lymphedema, which means making
the correct diagnosis can help avoid costly
and ineffective interventions. It can some-
times be difficult with lipedema patients,
however, to take the right measurements
for a perfect fit, as the process requires
considerable expertise. In most cases, these
patients have more pronounced fat deposits
in a lateral position on the thighs and in a
medial position on the knees. Problems get-
ting a suitable form of compression wear to
fit are also compounded by soreness under
pressure and the ankle shape associated
with “elephant legs”.
CDT can sometimes be combined and supple-
mented with intermittent pneumatic com-
pression (IPC). Recent years have also seen
the increasing use of surgery for lipedema
and lower extremities. Swelling and pain
increase during warm weather and under
stress. Lipedema can be diagnosed by taking
the patient’s (family) history and perform-
ing a clinical examination. The backs of the
hands and the feet are unaffected and Stem-
mer’s sign is always negative. The typical
distribution of fat nodes is a clear sign of
lipedema. There is, however, still no reliable
diagnostic test for the condition.
As such,
it is very important for physicians to be
familiar with the morphology and special
features of lipedema.
Significant underreporting suspected
The literature contains a wealth of figures
on the incidence of lipedema, although very
many cases are thought to go unidentified.
A specialist lymphedema clinic in Spain
indicated that 22.9 percent of its referrals
were diagnosed with some form of lipede-
A German clinic’s own data reveals
15 percent of patients were diagnosed with
some form of lipedema.
An epidemiologi-
cal study conducted by Szolnoky and his
colleagues in Hungary found 34 percent of
patients were diagnosed with a form of pure
lipedema. All other lipedema patients in the
study were found to have ancillary condi-
tions, such as a venous edema or a lymph-
edema. Földi calculated that 11 percent of
postpubescent girls have lipedema in one
of its various forms.
With several female
members of the same family often suffering
from the condition, a genetic disposition is
suspected in anything between 16 and 64
percent of cases.
Compression therapy as a staple
treatment strategy
Complex decongestive therapy (CDT) is gen-
erally recognized as the standard treatment
for lipedema based on clinical experience. It
consists of manual lymph drainage, physical
activity, multilayer compression supports,
and the use of compression stockings and
skin care tailored to an individual’s needs.
Basing a therapy regime around compression
treatment can help prevent the progres-
sion of lymphatic problems in the event
of lipedema and offer some relief from
symptoms. Assuming diagnosis is made
early, compression treatment has so far been
deemed sufficient to prevent progression to
stage I. There is, however, no international
Differences between lymphedema and lipedema
• Mainly women affected
• Mainly during puberty
• Symmetrical
• Painful
• Feet not involved
• Hematomas
• No erysipelas
• No response to dietary changes
• Stemmer‘s sign negative
• Men and women affected
• All age groups
• Asymmetrical
• Not painful
• Feet involved
• No hematomas
• Erysipelas
• Response to dietary changes
• Stemmer‘s sign positive
A thickened fold of skin on the toes caused by
protein fibrosis. A positive Stemmer’s sign only
occurs in cases of lymphedema.
“Lipedema can be diagnosed by
taking the patient’s (family)
history and performing a clinical
(Joyce Bosman)