LIPEDEMA

Lipedema

Lipedema is a chronic medical condition characterized by a symmetric buildup of adipose tissue (fat) in the legs and arms.
A common but under recognized disorder, lipedema may cause pain, swelling, and easy bruising.
It may be accompanied by an unusual texture within the fat that can feel like rice, peas, or walnuts beneath the surface of the skin.
The intensity of pain may range from none to severe, and its frequency may be constant, come and go, or only occur when the fat is pushed on.
​Limited public awareness of lipedema, coupled with few research-backed treatments, can lead to exacerbation of symptoms as well as physical and emotional distress. Common symptoms include fatigue, muscle pain, or easy bruising.

Lipedema occurs almost exclusively in females, with rare reports of development in men. Although believed to be prevalent, the exact incidence is not known.
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The causes of lipedema are not well understood. It is reported to start or worsen during puberty and other periods of hormonal changes, such as pregnancy and menopause. Research is underway to determine the biological role of hormones, genetics, inflammation, and metabolism in the condition’s development.

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Lipedema is not rare, but a proper diagnosis is rarely made

Despite initial medical reports from more than 75 years ago, there are no definitive diagnostic tests for lipedema.
​It is often misdiagnosed as obesity, lymphedema, Dercum’s disease, or chronic venous insufficiency. Underlying lipedema may also be present in patients with these conditions. Currently the only way to diagnose lipedema is to have a trained physician perform a physical examination with a review of the patient’s medical history. However, few physicians are comfortable diagnosing and treating lipedema because of the lack of diagnostic tests and research-backed treatments. Therapists may be confident in distinguishing lipedema from lymphedema. Surgeons who perform liposuction are able to remove fat but may not provide broad or long-term care.

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Stages of Lipedema

​Lipedema tends to be a progressive condition, unfortunately. It typically appears around puberty and progresses throughout life, depending on hormonal changes, stress, surgeries, and other circumstances. However, not every woman progresses to all stages. 
Different sources stage lipedema differently. Some list 2 stages, some 3, and some 4. Most sources use the 3-Stage model (like the picture shown above), but I think the 4-Stage model makes more sense.

​The following summary is adapted from Dr. Herbst's article on Rare Adipose Disorders:

• Stage One - Disproportionate pear shape, with somewhat increased fat. Normal skin surface which feels smooth and soft. Leg still has shape but may be considered somewhat larger or thicker than average by others. There can be some swelling (edema) during the day but it usually resolves overnight or with rest and elevation
• Stage Two - Skin texture begins to change from smooth to uneven with indentations ("orange peel" or "mattress" skin). Fatty deposits start to grow around knees and thighs, and some also develop larger arms or chest. Legs begin to thicken more and lose their shape, and "cankles" start to develop. Skin is rubbery or spongy and begins to feel nodular in places, like little beans under the surface. Edema can occur but doesn't resolve as easily as it has in the past
• Stage Three - Skin texture in hips and thighs has more of an "orange peel" look, and fat nodules are easier to detect. Large masses of tissue can form folds and ridges ("lobular deformations"), especially just above and below the knees and on the thighs. Cankles get worse and may begin to "overshoulder" the ankle. Swelling becomes more consistent and does not resolve with rest and elevation. If lymphedema starts to develop, hardening of connective tissues can start to occur, and skin starts feeling tougher
• Stage Four - Lipo-lymphedema develops (lipedema with secondary lymphedema). Larger masses of skin and fat overhang, making many complex folds and ridges with consistent swelling. Large gains in weight can occur, and mobility can be affected. Skin can become harder and/or discolored. In severe cases, lymph fluid can begin to leak from lymphatic vessels

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