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Diagnosis of lipedema

Lipedema is often diagnosed quite late as many doctors are not familiar with the disease. By then patients will have already had a long journey of suffering behind them, marked by self-doubt and uncertainty. Lipedema often occurs during puberty and so the typical symptoms such as riding pants manifest themselves at a time when the body is constantly changing anyway. It is very difficult for patients to recognize that these changes are part of a clinical picture. They often come into contact with lipedema for the first time via the Internet and television and eventually recognize their own complaints.

An experienced doctor can diagnose a patient with the naked eye (visual diagnosis), since lipedema is characterized by a characteristic stature. The extremities (arms and legs) are usually more voluminous and do not harmonise with a slender upper body, a narrow waist and delicate wrists and ankles.

Palpation

Also the palpation of the skin can give important indications of the disease. In the early stages of lipedema, the skin has a structure that feels like polystyrene beads. In later stages, these irregularities resemble more and more walnut-sized balls, yet the skin feels soft. If the doctor presses into the tissue during the examination, a dent only occurs for a short time.

Paradoxical pinch test for diagnosis

In order to determine lipedema, the so-called paradoxical pinch test can also be performed. One pinch the inside of the leg and one pinch the outside of the leg. If the patient feels the pain on the outside of the leg more than on the inside, lipedema is likely (healthy people would describe the pain exactly the other way around).

Stemmer’s sign

The lymphoedema can be diagnosed with the Stemmer’s sign. In this test, the skin fold over the second and third toe is attempted to lift. If the wrinkle is thickened, heavy or cannot be lifted at all due to the hardening of the tissue, Stemmer’s sign is positive and lymphedema is present. It should be noted that a negative Stemmer’s sign does not exclude lymphedema (false negative classification: the patient is ill, but the test does not indicate the disease).

Differential Diagnosis

Below we have summarized the most important distinguishing features for differential diagnosis.

Clinical PictureSymptomsDefinitionTherapy
Lipedema– Strong fat multiplication
– Severe disproportion of the affected areas
– edema tendency
– Pressure pain present
– Very strong haematoma tendency
Fat distribution disorder with disproportionate distribution of body fat on the extremities (mostly arms and legs)liposuction
compression
Manual lymphatic drainage
AIK (Apparative intermittent compression)
Lipohypertrophy– Strong fat multiplication
– Severe disproportion of the affected areas
– No tendency to edema
– Usually no pressure pain
– Inclination to hematoma possible
proliferation of the subcutaneous fat tissue by hypertrophy (abnormal growth)Liposuction
Lipedema with secondary lymphedema (lipolymphedema)– fat increase
– Disproportion present
– pressure pain
hematoma tendency
– Stemmer’s signs positive
– lymph cysts, lymph fistulas
Occurrence due to non-treatment or progression of lipedema (mixed form of lipedema and lymphedema). The lymph vessels change so that they are no longer able to transport the lymph fluid away properly.Liposuction Manual lymphatic drainage
compression
physical-exercise therapy
AIK (Apparative intermittent compression)
skin care
breathing exercises
Lymphedema– Fat multiplication possible
– feeble
disproportion of the affected areas
– Very strong tendency to edema
No
– Pressure pain present
– no hematoma tendency
Insufficiency of the lymph vessels in which the lymph fluid is no longer properly drained away and oedema forms.
Manual lymphatic drainage
compression
physical-exercise therapy
AIK (Apparative intermittent compression)
skin care
breathing exercises
Phlebodema– Oedema formation on arms and legs
– discoloration of the skin and varicose veins

Development by venous discharge disorder (e.g. chronic venous insufficiency or venous thrombosis)compression
AIK (Apparative intermittent compression)
Treatment of varicose veins
Cellulite– dents in the area of the thighs, hips, buttocks or upper arms
– No pressure pain

Changes in the fatty tissue in the subcutaneous tissue of the buttocks and legs. Slight congestion of lymph fluid due to pressure of larger fat cells on the blood vesselsLymphatic Drainage Liposuction
weight reduction
Adiposity– Fat multiplication strongly pronounced
– Disproportion of the affected areas possible
– Edemas can occur
– No pressure pain present
– No tendency to hematoma
Nutritional and metabolic disease with severe obesity with abnormal increase in body fat.

weight reduction